Tips To Make California Health Marketplace Work For You

Open Enrollment for the Health Marketplace begins November 1st, 2015 for 2016 coverage. Here are some things to know and tips to make California Health Marketplace work for you. Most Americans must purchase insurance, get an exemption or pay a per monthly fee for every month they go without coverage. If you don’t like your current plan or don’t have insurance, you can apply for a marketplace plan to see your options. Applying doesn’t mean you have to enroll. The Open Enrollment period allows you to enroll for insurance offered in the Health Marketplace and apply for financial assistance and applications are being taken now for coverage to begin in 2016. If you have a life-changing event such as the loss of a job, death of a spouse or birth of a child, you may be eligible for special enrollment within 60 days of the event outside of Open Enrollment.

When you are getting ready to apply or renew your policy, Have the following family information available:
1. Last years tax information for you and your family
2. Projected incomes for this year
3. Medical history – Pre-existing conditions and gender will no longer affect the cost of your insurance.
4. Social Security Numbers (or document numbers for legal immigrants)
Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements)
5. Policy numbers for any current health insurance plans covering members of your household.
6. Any other important information that could affect your health insurance premium or coverage options.

Choosing an Insurance Plan
After filling out your information you will be able to start shopping for health insurance. You will be able to compare plans, premium rates and benefits.

Regardless of what tier of plan you purchase all plans must cover:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and rehabilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Types of Health Insurance Plans
There are a number of different tiers of plans available on your health insurance exchange.
1. Bronze plans split covered expenses 60-40 on average. A Bronze plan is a good choice for those who don’t plan on using many medical services. Many low-income Americans may qualify for free or very low-cost Bronze plans.
2. Silver plans split covered expenses 70-30 on average.
3. Gold plans split covered expenses 80-20 on average.
4. Platinum plans split covered expenses 90-10 on average. Platinum plans have the lowest out-of-pocket costs and the highest monthly premiums.
5. Catastrophic Coverage is available to some people under 30 and those with hardship exemptions. Catastrophic plans only cover the bare minimum health benefits and have a limited network. You’ll have high out-of-pocket costs and a high deductible.

Subsidies or financial assistance are given in the form of tax credits based on your income and are paid by the health insurance companies toward your premium on a monthly basis. Keep in mind that you may lose or gain cost assistance as your income fluctuates throughout the year. If your income increases the difference will be reflected on your tax returns.

Facts about Premium Health Insurance Tax Credits/Subsidies:
Tax credits can:
1. Lower the cost of your premium.
2. Reduce the amount of the premium you will pay for insurance.
3. Help low-income and middle-income individuals and families
4. Are available to individuals and families who meet certain income requirements.
5. Can be applied to the cost of your health plan when you enroll – you do not need to wait until you file a tax return at the end of the year.
6. Are paid directly to your health plan. These tax credits are paid by the Health Insurance Marketplace to your health plan to keep your out-of-pocket costs low.
7. Will be adjusted at the end of the year based on your actual income. At the end of the year, the tax credits may be adjusted if your income is different than you anticipated. This means you will want to notify your insurance agency if your income changes.

Hopefully, these tips to make California Health Marketplace work for you have helped! Our certified Covered California insurance agents can help you calculate the cost of insurance for you and find the best plans at the best price. Give us a call today and see what great health insurance options are available.


AUTHOR - Ali Nagy