Here are some basics about who should sign up, when to sign up, where and how to do it.
Do I need to sign up?
The easiest answer to this is that everyone, regardless of age or employment, should go online to HealthCare.gov, answer the questions and find out.
HealthCare.gov will alert people if they don’t qualify for Marketplace insurance and steer them to other programs if they qualify.
In general, those who already have insurance through an employer will not need to sign up for insurance on the Marketplace and will receive no benefit in doing so. Those who are on Medicare (health insurance for the elderly and disabled), MaineCare (the state’s version of Medicaid insurance), or who receive Veterans Administration Benefits already have health insurance and do not qualify.
How do I sign up? Short answer: HealthCare.gov
Maine residents can purchase health insurance on their own from a private insurer, or they can find out about coverage from a health insurance company through the Marketplace in several ways: online, by mail, or in-person with the help of a trained assistant who can help with eligibility and signing up.
Trained assistants, known as navigators, can be found in Maine through Consumers for Affordable Health Care at 1-800-965-7476, online at mainecahc.org, or via email at firstname.lastname@example.org.
Consumers for Affordable Health Care will direct applicants to local, in-person help with the application process and mail a printed application, if requested.
The federal Marketplace website, HealthCare.gov, will have an Internet chat-line to assist people with completing online or mail-in applications. Starting October 1, they will also offer telephone help around the clock at 1-800-318-2596.
Either with help or without it, people can use HealthCare.gov to calculate their eligibility for insurance through a company on the Marketplace for individuals and families.
How much will insurance cost?
The real monthly cost of basic insurance available from a company on the Marketplace will not be available until October 1.
That said, the Marketplace is set up so that the lower a person’s income, the less they will have to pay for health insurance. Income guidelines are fairly generous. For example, a person who makes less than $46,000 a year will get a break on costs. A family of four will get a break if they make less than $94,000 a year.
In general, midcoast Mainers in their thirties who are nonsmokers will be eligible for a monthly insurance rate of approximately $250 a month for standard full coverage. A 50-year-old nonsmoker would get a rate of about $400 a month. But the actual cost of health insurance per month could be less than half that, depending on the federal
Since the Marketplace doesn’t open until October, Kaiser Family Foundation has created an online calculator that can give a rough estimate of the monthly cost after the subsidy is applied.
A 30-year-old single person who makes about $16,000 a year would pay about $540 a year for health insurance (about $45 a month); if they made around $30,000 a year they would pay about $2,500 a year for insurance, or about $208 a month.
A family of four that makes about $32,000 a year would pay about $1,030 a year, or about $85 a month, for insurance for the whole family. If that family made $64,000 a year, they would pay about $5,580 a year, or about $465 a month, to cover the whole family.
Notably, some rates are higher for smokers, but would not be higher for those who already have health problems. The Kaiser Family Foundation subsidy calculator is easily available at mainecahc.org.
What will the Marketplace health insurance plans cover?
Starting in 2014, insurance companies must make the switch from a hodge-podge of health care coverage to insurance that, at a minimum, offers standard comprehensive coverage for the following:
• Outpatient care
• Emergency care
• Maternity and newborn care
• Pediatrics, including dental and vision
• Mental health and substance abuse treatment and counseling
• Rehabilitation, related services and devices
• Lab tests
• Preventive care
• Chronic disease management
Insurers will be required to offer this basic level of
coverage, whether insurance is purchased through the Marketplace or not. Under the new health care law, citizens and legal residents cannot be denied coverage, nor can it cost more if they have pre-existing conditions or if they are female.Will there still be co-payments and deductibles? Yes
The Marketplace exchange will allow people to compare important features of the plans available in the state side-by-side and compare monthly premiums, deductibles, and out-of-pocket costs for different levels of coverage.
The income-based subsidy will be included in the calculation, so people will know the full monthly cost of health insurance before they enroll.
There is no one-size-fits-all plan or one-size-fits-all price. People must decide which health insurance company and plan they want, but under the new health care law, all health insurance plans must cover at least 60 percent (the Bronze Plan) of the average costs of standard health care.
People can upgrade to more coverage – 70, 80, 90 percent coverage (Silver, Gold, and Platinum Plans, respectively). They can add dental and vision care and choose lower deductibles. People will be able to keep their primary-care doctors, if the doctors are on the list of providers for the health insurance company they choose.
Those under the age of 30 and a small number of hardship cases will be able to buy a plan that offers catastrophic coverage only. Most people will not have that option.
What is the penalty if I don’t sign up?
There is no penalty for those who have health insurance through an employer or have public insurance (MaineCare, Medicare, or Veterans health care programs or TRICARE, Peace Corps Volunteer benefits, or CHIP, the Children’s Health Insurance Program), or for those with very low incomes who do not qualify for a subsidy.
Those who are registered in a federally recognized Indian tribe are also exempt from penalties. For other exempt groups, see HealthCare.gov.
Those who are eligible for health insurance on the Marketplace who don’t get coverage in 2014, either through a company on the Marketplace or on the individual private market, will pay a penalty.
In 2014 the penalty is $95 per adult ($47.50 per child) or 1% of income, whichever is higher. The family maximum penalty is $285.
In 2016, the penalty will be $695 or 2.5% of income.
The fee will be deducted from any future tax returns. There are no liens or criminal penalties for failing to pay the fee.
Those who are unemployed will be exempt if insurance is unaffordable, based on income.
Gather your documents
Documents needed to sign up for health insurance on HealthCare.gov include:
• Social Security number (or document number for legal immigrants)
• Employer and income information for every member of the household that needs coverage (W-2′s or Wage and Tax Statements)
• Policy numbers for current health insurance plans that cover any member of the household
• If an employer offers health insurance and an employee is eligible, the employee will need to complete a Employer Coverage Tool. The form is available for download and printing from HealthCare.gov or from Consumers for Affordable Health Care at mainecahc.org.
What if I own a small business? Do I have to offer health coverage or face a penalty?
Businesses with under 50 employees don’t have to offer health insurance and are not subject to a penalty if they don’t, but may receive tax benefits for doing so.
Those who employ over 50 employees may face penalties (Employer Shared Responsibility Payment) in future years if they do not offer insurance that meets the basic standards listed above.
For more information, see HealthCare.gov.