5 Things Consumers Should Know About Marketplace Health Insurance

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With Open Enrollment underway, many consumers may be faced with questions as they consider their health care coverage options for 2019. In order to take full advantage of your options this year, it’s important to know what’s changed in health care and the best way you can adapt to those changes.

CareSource, a nonprofit, multistate health plan, aims to help Hoosiers find and afford the best health insurance for themselves and their families. While the percentage of consumers without health insurance has decreased by half since 2013 according to the Kaiser Family Foundation, there are still about 45,000 people in Indiana without insurance coverage. If this is you, and you are on the fence about buying health insurance through the Marketplace, here are some tips when considering enrollment this year:

1. Open enrollment is just as short as last year's, so act now.

Open enrollment ends Dec. 15. This means that consumers need to act now to assess their coverage needs based on their life circumstances to make the best decision for their family. Look at premiums, but also check which doctors are in-network. Even if a plan did not include your doctor last year, check again for 2019. More doctors may be in network beginning on January 1, 2019. Research coverage options so that you’re ready to enroll when the Marketplace opens. Education is important, because it helps consumers understand changes that may impact their coverage selection.

2. As a result of the Marketplace stabilizing, more options are available.

In the past, there has been confusion and turbulence surrounding the Marketplace. But now in its fifth year, the Marketplace has stabilized and is here to stay. Premiums are stabilizing, and there tax credits and subsidies available for those who qualify based on their income. Researching all these options is important, because it helps you to select the best plan for you and your family.

3. Premium subsidies are available for those who qualify based on income.

Approximately 75 percent of Marketplace consumers have incomes that qualify them for tax credits and subsidies that can reduce premiums; some may even qualify for premiums as low as zero. It’s important to complete the application process to see if you qualify.

4. Examine short-term plans closely.

With cheaper premiums than ACA-compliant plans, short-term insurance plans are tempting to young, healthy people who are looking for “catastrophic-only” coverage to keep their expenses down. But these plans are not required to provide comprehensive coverage of medical needs and often exclude people with pre-existing conditions. Originally designed to serve as a three-month bridge to cover gaps in coverage, they are not required to comply with federal health care laws that protect consumers. These plans come with a long list of exclusions, ranging from diabetes and disabilities to injuries and maternity care. They also often carry high deductibles, don’t cover prescription drugs outside of a hospital and don’t qualify for subsidies. If you are considering these plans, examine closely their coverage, exclusions and costs.

5. Dig into what Marketplace plans cover and what they cost.

Decide whether a Bronze-level plan, which is lower in premium cost than other Marketplace plans, is right for you. You may want to set up a health savings account with it to help cover your deductible cost. The Marketplace plan levels include Bronze, Silver, Gold and Platinum, which represent a spectrum starting with high-deductible, low-premium coverage, up through low-deductible, high-premium coverage.

Steve Smitherman is president of CareSource Indiana.

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