Questions and Answers about the
Affordable Care Act Insurance Marketplace
- “I understand I have until February 15, 2015, to enroll for coverage through the Health Insurance Marketplace. If I sign up during that three-month window, when will my coverage begin?”
- If approved, you must enroll and pay your first premium by the 15th of the month for coverage to begin on the 1st day of the next month.
For example: December 15, 2014 is the last date to enroll for coverage that starts January 1, 2015.
If you enroll and pay your first premium on the 16th of the month or after, your coverage will not begin until the first day of the following month.
For example: You enroll December 16, 2014. Your coverage will not begin until February 1st, 2015.
Date of Enrollment / Renewal Effective Date of Coverage Nov. 15, 2014 - Dec. 15, 2014 January 1, 2015 Dec. 16, 2014 - Dec. 31, 2014 February 1, 2015 Jan. 1, 2015 - Jan. 15, 2015 February 1, 2015 Jan. 16, 2015 - Jan 30, 2015 March 1, 2015 Feb. 1, 2015 - Feb. 15, 2015 March 1, 2015
- “I know there are different levels of health plans on the federal Marketplace. How are they different and how much do they cost?”
- There are 5 categories of coverage in the Marketplace. Plans in each category pay different amounts of the total costs of an average person’s care. This includes the plans’ monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. The actual percentage you’ll pay in total or per service will depend on the services you use during the year.
Levels of Coverage Plan Pays You Pay (In addition to the monthly plan premium) Bronze 60 Percent 40 Percent Silver 70 Percent 30 Percent Gold 80 Percent 20 Percent Platinum 90 Percent 10 Percent Catastrophic These plans pay less than 60% of the total average cost of care on average. They’re available only to people who are under 30 years old or have a hardship exemption.
- “What should I consider when choosing a plan?”
- It might be tempting to choose a plan simply because it has the lowest monthly premium. There are many other things to consider before making a plan selection.
Here are some questions to ask yourself when making the decision:
What will guide a person in choosing a “Qualified Health Plan” (QHP)? Are my doctor and specialist on the health plan network? Are my medications covered? Can I get dental coverage? Which plan fits my budget but still meets my needs?
- “Can I view plans in my area without creating a Marketplace account and before going thru the process of completing the application?”
- Yes. You can preview plans in your area here. Keep in mind that when you preview health plans, the plans are only health insurance premium estimates and estimated savings you may qualify for based on your income. The estimated quote uses only the basic 2015 income information you provide. The Marketplace application itself will ask for more 2015 income and household details.
- “I heard that I can be penalized for not having health insurance. How does this work?”
The fee for not having health coverage is calculated one of two ways. If you or your dependents don’t have insurance that qualifies as minimum essential coverage you'll pay either a percentage of your household income or a flat fee -- whichever is higher.
The fee for not having coverage in 2014If you did not have coverage in 2014 you will need to pay a penalty when you file your 2014 Federal tax return.
- 1% of your yearly household income.(Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
- $95 per person for the year ($47.50 per child under 18).The maximum penalty per family using this method is $285.
The fee for not having coverage in 2015If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:
- 2% of your yearly household income.(Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
- $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
The fee after 2015The penalty increases every year. In 2016 it’s 2.5% of income or $695 per person. After that it's adjusted for inflation. Additional information regarding penalties can be found here.
- “Can I buy insurance through the Marketplace even if I have a serious health problem?”
- Yes. You cannot be denied coverage due to a pre-existing condition. And the amount you pay for a health plan will not be affected by your health status. This means that you can't be charged more because of your health problem.
- “How does the Affordable Care Act specifically help women?”
- Women have rights now that never existed before. You can't be charged more than men just because you're a woman. In the past, women routinely paid 20% to 40% more than men for the same coverage. You can't be denied coverage because you're pregnant and you get free preventative care.
- “If I don’t qualify for insurance through the Marketplace,
what can I do?”
- You can apply to see if you are eligible for AHCCCS, Arizona’s Medicaid. You may qualify for Medicaid based on your income and family size.Keogh Health Connection can help you with your questions and offers FREE application assistance. Call us at 602-266-0379 for more information or to schedule an appointment.Find more information about what is required to apply:
Time Left before Marketplace
Open Enrollment Period Ends
Helping Arizonans Connect To
The Insurance Marketplace
Cover Arizona is a coalition of more than 600 organizations statewide that is committed to increasing health coverage. We are engaged in building awareness of opportunities available through the Health Insurance Marketplace and AHCCCS, Arizona’s Medicaid. Members are actively engaged in local outreach activities and are committed to ensuring that trained enrollment assisters are available for consumers seeking coverage.
See Keogh clients talk about their
Health Connection experience.