Health insurance marketplace open
One company offering multiple plans in Marietta
Just more than a month remains for anyone interested in marketplace health insurance coverage to sign up.
The open enrollment period started Nov. 1 and continues through Dec. 15 – after that, anyone seeking health insurance through the exchange will need to qualify for special circumstances.
A few things have changed this year, including removal of the tax penalty for people who decide not to buy health insurance. Additionally, new low-premium policies termed “short-term” health care have become available, primarily aimed at people who don’t anticipate using their medical insurance regularly but who still want coverage in the event of a catastrophe. Those policies, which are available for as little as a month or as long as three years, also might suit the needs of workers who change jobs frequently and need a bridging policy between employer-sponsored plans.
Such policies are available for as little as $84 a month, although the deductible amounts are high and they often don’t cover pre-existing conditions and other health expenses that are mandatory for plans offered on the marketplace exchange.
Open enrollment also applies to prescription drug plans, and like the overall medical plans, much of the enrollment work and decision-making has been set up for the internet.
Most residents of Marietta who have insurance will be covered at least in part by Medicare or Medicaid, or obtain their insurance through an employer sponsor.
For those who are using the marketplace to get their insurance, the complex process is made easier through the government-operated website healthcare.gov.
The only company offering plans for the Marietta Zip code, 45750, is CareSource, a large nonprofit headquartered in Dayton. CareSource is offering about a dozen plans for 2019.
The plans, like most, offer a range of premiums, deductibles and out-of-pocket limits, with lower premiums generally tied to higher deductibles and the reverse. The challenge is to accurately estimate how much health care you’ll need.
An average family in Marietta – two adults, two children under 18, with a household income of $40,000, can expect at least $4,281 in annual costs, according to the marketplace exchange, with that estimate tied to lowest premiums and moderate use of health care resources, such as physician visits, during the coming year. That includes a federal tax credit of $764 a month, which reduces the cash premium to zero but exposes the family to up to $13,300 in out-of-pocket cash expenses.
The $4,281 estimate of annual costs assumes “medium use” of health care resources, such as regular doctor visits and prescription drugs but no hospital visits.
Robert Brett, vice president of marketplace for CareSource, said despite the penalty for not having health insurance being removed, he expects “robust”enrollment this year.
“The marketplace is stabilizing and is still the best option for finding a plan to fit a range of health care needs and finances,” he said.
In terms of cost, he said, plans have been modified to focus on health outcomes. The costs have gone up 16.8 percent overall compared to last year, he said, influenced by higher cost of medical services and prescription drugs, along with removal of the individual mandate from the Affordable Care Act and the availability of short-term plans that don’t meet the ACA guidelines and are not sold on the marketplace exchanges.
Brett advises consumers to shop early and shop carefully for insurance.
“They should assess coverage based on their life circumstances and dig into marketplace plans and what they cost, as well as checking which doctors are in-network,” he said.
Short-term plans are now available at low cost, but they aren’t for everybody, he said.
“Consumers should be wary of short-term insurance plans if they have any medical conditions or need prescription drug coverage,” he said. “They don’t cover essential health benefit needs. They also don’t qualify for the premium subsidies that ACA-compliant plans do.”
Open enrollment season brings other headaches for consumers, one of which is scams.
“We encourage being cautious online,” said Kate Hanson, a public information officer for the Ohio Attorney General. “Be sure you haven’t landed on a look-alike site. Check the web address for .gov to make sure you’re on a government website.”
Phone calls are another source of deception. Hanson said consumers should be cautious about interacting with anyone on the phone who asks for personal information.
“It could be a call originating from another country, because it’s easy to spoof a local number in an attempt to fool people into thinking it’s a local call,” she said.
The best strategy when getting such a call is just to hang up, she said.
More information is available at ohioprotects.org and ohioattorneygeneral.gov, she said.
Open enrollment for health insurance
•Deadline: Dec. 15.
•Marketplace plans available in Zip code 45750: CareSource, 11 plans.
•Costs for family of four with a household income of $39,900 (median income for county): $4,281 to $7,253 (total cost of estimated out-of-pocket plus premiums, taking into account federal subsidies. Some families may qualify for Medicaid assistance.)
•To enroll online: healthcare.gov
Source: Times research.