Adding Health Care to Your Holiday Shopping List

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An informational booth provided essentials about the EnrollSA's coalition. Photo courtesy of SA2020.

The EnrollSA event held Nov. 15 underlined the benefits of basic health care to the San Antonio community. Image courtesy of SA2020.

Nobody I know gets excited about shopping for health insurance, especially in late November when shopping energies are devoted to Thanksgiving dinner prep and surviving Black Friday sales.

But there’s a good reason to add “buy health insurance” to your holiday shopping list if you don’t have insurance or don’t like the plan you have now. It’s open season to enroll for 2015 health care plans in the insurance exchange marketplace created after passage of the Affordable Care Act (ACA). The season ends Feb. 15, and if you want insurance to begin Jan. 1, you need to enroll by Dec. 15.

We offer this guide to the health insurance marketplace to make your shopping a little easier.

What is the Health Insurance Marketplace?

It’s the state’s price comparison website for subsidized health insurance. Since Texas doesn’t have one, we use the federal site: www.healthcare.gov. Call centers and in-person assistance are available if computers aren’t your thing.

These private health insurance plans are standardized and comply with the ACA (a.k.a. Obamacare). Plans cannot deny coverage on the basis of a preexisting condition. They must offer affordable basic benefit package that includes prevention, and protection against catastrophic costs. While the plans are standardized, availability and cost vary across states and counties.

Screenshot of www.healthcare.gov.

Screenshot of www.healthcare.gov.

For 2015, in Bexar County, the exchange has 95 plans offered by eight companies: Aetna, Allegian Health Plans, Assurant Health, Blue Cross and Blue Shield of Texas, Community First Health Plans, Humana, Superior HealthPlan, United Healthcare.

The ACA’s health care portal lets you preview the plans before you commit to filling out the application. Find a plan you like? You’ll be guided through the application steps online.

All the plans offer the same essential benefits, including hospitalization, prescriptions drugs and maternity care.  Plans also have four levels that affect the cost of the premium and the amount you will spend out of pocket. 

Platinum. Covers about 90% of health care costs.

Gold. Covers about 80% of health care costs.

Silver. Covers about 70% of health care costs

Bronze. Covers about 60% of health care costs

General rule of thumb: Platinum premiums are highest, but you pay less out-of-pocket. Bronze premiums are lowest, but you pay the highest out-of-pocket costs.

Who can buy insurance from the Marketplace?

From www.healthcare.gov.

From www.healthcare.gov.

Most people are eligible. You must live in the United States, be a U.S. citizen or national (or be lawfully present), can’t be currently in jail or prison, and cannot have Medicare coverage.

Will I qualify for financial assistance to pay the premiums?

Fill out the application with your income and other information, The website will automatically calculate your assistance. www.healthcare.gov also has a formula for you to “guesstimate” your assistance. Subsidies are given as refundable tax credits.

How and where do I enroll?

Here’s that link, one more time, for good measure: www.healthcare.gov.

Want help in-person? www.localhelp.healthcare.gov gives 69 locations where you can get free assistance from a trained “navigator” or certified application counselor. Also check out www.enrollsa.com and www.bexarhealthmarketplace.org.

Collect the following information about you and your family before visiting the marketplace or getting in-person help:

  • Last year’s tax information for you and your family
  • Projected incomes for this year
  • Social Security Numbers, or document numbers of legal immigrants.
  • Employer and income information for every member of your household who needs coverage (pay stubs, W-2 forms, Wage and Tax Statements)
  • Policy numbers for any current health insurance plans covering members of your household.
  • A complete Employer Coverage Tool for every job-based plan you or someone in your household is eligible for

When can I enroll?

You can enroll during the open enrollment period from Nov. 15 to Feb. 15, 2015. This is the only time you enroll in a plan, switch plans or get help to reduce the cost, without qualifying for a special enrollment period.

What’s the penalty if I don’t get health insurance?

In 2015, you’ll pay the higher of these two amounts:

$325 per person for the year. Maximum penalty per family is $975. OR

2% of household’s taxable income.

Exemptions are available.

What enrollment help is available for people who are fluent only in Spanish?

Visit Spanish language website www.cuidadodesalud.gov to compare health plans, see about tax credits or subsidies, and enroll electronically

Spanish language operators at call center 1-800-318-2596.

Spanish-speaking enrollment assistants at Centro Med.

I won’t say “Happy Shopping.” You won’t experience the thrill of snagging a great bargain from a sales rack. But health insurance is a gift that will keep on giving throughout 2015, especially if you or a family member gets sick or injured.

*Featured/top image: The EnrollSA event held Nov. 15 underlined the benefits of basic health care to the San Antonio community. Image courtesy of SA2020.

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