Open enrollment at the Healthcare Insurance Marketplace began Oct. 1, 2013 and continues through March 31, 2014. It’s estimated that the majority of Americans will have signed up and be covered by an insurance plan by that time. Those who don’t will be subject to penalties and fines on their income tax returns.
The Marketplace is the backbone of Obamacare and will determine how healthcare insurance will be delivered.
The Marketplace provides consumers with a central location to purchase the healthcare that best fits their individual needs.
Prices vary and are dependent upon the applicant’s annual income and geographic location.
Purchasing A Plan
There are four types of coverage that consumers should be aware of and with which clinicians should be familiar if they’re to talk with patients about their plans.
The Marketplace offers a Bronze, Silver, Gold, Platinum and Catastrophic policy, each with its own set of parameters.
Bronze and Silver plans can cost up to 9.5 percent of an individual’s income.
Gold and Platinum policies can be 12.5 percent of the applicant’s yearly income.
Samples prices and coverage can be viewed on the Marketplace website, but the only way to ascertain actual costs is to apply.
Catastrophic plans are available for those under the age of 30. Individuals over 30 who have received an exemption are also eligible for the coverage.
These types of plans typically cost less but have very high deductibles. In 2014, the maximum out-of-pocket for any Marketplace plan is $6,350 for individuals and $12,700 for families.
Many consumers will be eligible for federal subsidies to help them pay for insurance on the Marketplace, but consumers need to examine a plan’s monthly premium, co-pays and deductibles carefully before committing to an insurance policy.
Costs are expected to change and many predict they will go higher. Clinicians need to understand what’s offered if they’re to advise patients on costs and options that will best fit individual health needs.
Facing Fines
People who don’t qualify for Medicare, Medicaid or an employer plan must enroll in healthcare coverage at the Marketplace.
Those who haven’t enrolled or received an exemption will be fined on their income tax return through Obamacare’s Individual Mandate Tax.
In 2014, the fine for no insurance will be $95 per adult and $47.50 for children, or 1 percent of taxable income.
Those amounts increase to $325 per adult and $162.50 on children, or 2 percent of income in 2015.
The penalty for non-compliance in 2016 jumps to $695 for adults and $332.50 for children, or 2.5 of taxable income.
After 2016, fines will be adjusted upward for cost of living increases.
To remain current on Obamacare and be able to advise patients, clinicians will need the In Touch EMR and In Touch Biller PRO.
The integrated systems can be used to educate patients about their healthcare insurance and the core preventative services provided, while facilitating quick turnarounds on reimbursements.
