Coverage you can afford, understand & use.
The Health Insurance Marketplace (sometimes referred to as the Health Insurance Exchange) is an online marketplace that allows you to purchase health insurance at a competitive rate and maybe even qualify for lower costs. Some states use the federal Marketplace. Other states, such as Kentucky, have created their own Marketplace. The Kentucky Marketplace is called kynect.
Regardless of the state, the Marketplace offers a solution for people who are currently uninsured. It may even offer a better option for some who are paying for high cost health insurance now. It is designed to be a "one stop shop" option where you can compare policies sold by different companies. Purchasing insurance can be confusing, so information on the plan benefits is standardized so that it is easier for you to compare costs and quality.
Enrolling through the Marketplace is the only way you can qualify for help paying your insurance costs, based on your income and family size.
In Kentucky and Ohio:
$16,105 to $46,680 for an individual
$21,707 to $62,920 for a family of 2
$27,310 to $79,160 for a family of 3
$32,913 to $95,400 for a family of 4
$38,516 to $111,640 for a family of 5
$44,119 to $127,880 for a family of 6
$49,721 to $144,120 for a family of 7
$55,324 to $160,360 for a family of 8
$11,670 to $46,680 for an individual
$15,730 to $62,920 for a family of 2
$19,790 to $79,160 for a family of 3
$23,850 to $95,400 for a family of 4
$27,910 to $111,640 for a family of 5
$31,970 to $127,880 for a family of 6
$36,030 to $144,120 for a family of 7
$40,090 to $160,360 for a family of 8
If you are an Ohio or Indiana resident, visit HealthCare.gov.
If you are a Kentucky resident, visit kynect.ky.gov.
Visit these websites to learn about the health care laws and their impact on you.
If you have a qualifying life event, such as the birth of a child or loss of other health coverage, you can enroll during a special enrollment period.
Open enrollment for 2015 starts November 15, 2014, when you can access these sites to apply for coverage, compare available health insurance plans and enroll in a plan.
Federal law requires most people to have health insurance or pay penalties. This is part of the Patient Protection and Affordable Care Act, otherwise known as health care reform.
So, while you do not have to buy insurance from the Health Insurance Marketplace, most people have to be covered or pay a penalty. Using the Marketplace allows you to compare available plans, ensure you receive essential health benefits and determine your eligibility for cost savings.
If your children are under age 26 and meet certain requirements, you can insure them under your family policy if the health insurance plan covers dependents. This is true even if your children live on their own. Coverage up to age 26 is only a minimum. State rules and individual insurance plans can extend dependent coverage past age 26.
Before the health care reform law, insurance companies could stop covering dependent children at age 19 or when they were no longer full-time students.
In general, essential health benefits are covered under the plans offered through the Marketplace. All plans cover the following services:
Some plans provide additional benefits, for example, adult dental and vision care. Plans range from basic with minimal coverage to all encompassing high-end plans.
The health care laws are designed to protect you and your family. Health insurance companies can't refuse to cover you just because you have a chronic or pre-existing condition. In addition, they can’t charge more for women than for men. All of the plans offered through the Marketplace comply with these health care laws.
Yes. All health insurance plans offered through the Marketplace cover preventive services at no cost to you. This means you do not have to pay a copayment or coinsurance even if you haven't met your yearly deductible.
Preventive services are designed to prevent, identify and treat diseases early. These include flu shots and immunization vaccines, screenings to identify diseases, contraception and mammograms for women, behavioral assessments for children and much more.
If you have a qualifying life event, such as the birth of a child or loss of other health coverage, you can enroll during a special enrollment period, which ends 60 days after the life event.
Starting on November 15, 2014, you can enroll in a health care plan for 2015 through the Marketplace during open enrollment. You must enroll by December 15, 2014, if you want new coverage to begin January 1, 2015.
Open enrollment will close on February 15, 2015. This means that you will have three months, from November 15, 2014 through February 15, 2015, to buy health insurance from the Marketplace. Remember, you must have health insurance or pay a penalty.
In order to enroll through the Marketplace, you will need the following information for each family member to be covered:
If you bought coverage through the Marketplace in 2014, you will be notified if you are eligible to continue with the same coverage in 2015 and if your options for financial assistance have changed.
This process begins when the Marketplace sends you an annual redetermination notice. You need to review, sign and return this notice promptly. If any of the information is inaccurate, contact the Marketplace. If you do not sign and return the notice within 30 days, the Marketplace will assume the information is correct.
The Marketplace will then notify you with a final decision regarding eligibility for coverage and financial assistance, including whether you are eligible for programs such as Medicaid or the Children’s Health Insurance Program (CHIP).
If you are eligible to continue to receive Marketplace coverage, you can either keep your current plan or change plans during open enrollment, which is November 15, 2014 to February 15, 2015. You will be automatically reenrolled in your current plan if you do nothing. If your current plan’s benefits have changed, you will be notified of these changes.
If you enrolled in a Marketplace health insurance plan last year and the Marketplace has determined that you remain eligible for Marketplace coverage, you will be automatically reenrolled in the same plan for 2015 that you selected for 2014. If the cost or coverage details of your plan have changed from 2014 to 2015, your insurance plan will notify you of these changes.
If you enrolled in a Marketplace health insurance plan last year and the Marketplace has determined that you remain eligible for Marketplace coverage, you can change to another Marketplace plan during open enrollment, which is November 15, 2014 to February 15, 2015. To change plans, go to the Marketplace, access your account, shop for plans and select the plan that best suits your needs.
The cost of health insurance through the Marketplace depends on the plan you choose, your age and your tobacco use. Regardless of the plan you choose, all costs are stated up front so you’ll know how much you’ll be paying and what you’ll be getting before you make a choice.
You may qualify for tax credits that will lower your monthly payments based on family income and size. The Marketplace will show you the amount of these lower payments when you enroll starting November 15, 2014.
When you buy health insurance coverage through the Marketplace, you may be able to get a premium tax credit or subsidy that can lower the amount you pay each month for your premium. The amount of your tax credit depends on your household size and income.
When you enroll through the Marketplace, you will find out the amount of your tax credit. At that time, you can choose to apply the amount equally to your monthly premium payments or you can wait until you file your federal tax return.
If you apply the amount to your monthly premium, you get the benefit of lower monthly payments throughout the year. If you apply some or all of your tax credit to next year’s tax return, you increase your chance of getting money back at tax time.
When you enroll, you estimate your earnings for next year, and this estimate determines your cost savings. You must report any income change, up or down, that impacts your eligibility for cost savings to the Marketplace at HealthCare.gov in Ohio and Indiana and at kynect.ky.gov in Kentucky. Otherwise, you may miss out on the cost savings or end up owing money if you no longer qualify for the cost savings.
So, if your income changes your estimated earnings for the year, for example, through a job change or job loss, you should report it to the Marketplace.
You must also notify the Marketplace in the following situations:
If you don't have health insurance coverage, you may have to pay a penalty at tax time. This penalty is also referred to as the "individual responsibility payment" or "individual mandate." You also have to pay for all of your health care.
The penalty takes effect starting with your 2014 federal income tax return. Most people will file this return in 2015.
The penalty in 2014 is calculated in one of the following ways. If you or your dependents don’t have qualifying insurance, you'll pay whichever of these amounts is higher:
The way the penalty is calculated, a single adult with household income below $19,650 would pay the $95 flat rate. A single adult with household income above $19,650 would pay an amount based on the 1 percent rate. (If income is below $10,150, no penalty is owed.)
The penalty increases every year. In 2015 it’s 2 percent of income or $325 per person. In 2016 and in later years it’s 2.5 percent of income or $695 per person. After that it's adjusted for inflation.
Insurance protects you from high costs when something bad happens. No one plans to get sick or hurt, but most people need to get treated for an illness or injury at some point, and health insurance helps pay these costs. You get health insurance to protect you when you need medical care.
When you understand how health insurance works, it helps you be an informed consumer so you can find coverage that fits your needs.
Health insurance is a contract between you and your insurance company. You buy a plan or policy, and the company agrees to pay part of your medical costs when you get sick or hurt. Even when you need care that costs more than you pay in premiums and deductibles, insurance will cover the care you need. A standard health insurance plan also gives you access to preventive care to keep you healthy, like vaccines and check-ups. Many plans also cover prescription drugs.
Your health insurance plan will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations.
You’ll usually pay a premium every month for health insurance, and you may also have to pay a deductible once each year before the insurance company starts to pay its share. How much you pay for your premium and deductible is based on the type of insurance you have.
Just as important as the premium cost is how much you have to pay when you get services. Examples include:
What your policy covers is often directly related to how expensive the health insurance policy is. The policy with the cheapest premium may not cover as many services and treatments.
A deductible is an amount some insurance plans require you to pay once each year before the insurance company starts to pay its share. For example, let's say you have a $200 deductible. You go to the doctor and the total cost is $1,000. You pay the first $200 to cover the deductible, and then your insurance pays the remaining $800.
Coinsurance or a copayment is an amount that you pay as your share of the cost when you get a medical service, like a doctor's visit or a prescription. Coinsurance is usually a percentage amount (for example, 20% of the total cost). A copayment is usually a set dollar amount (for example, you might pay $10 or $20 for a prescription or doctor's visit).
This is the maximum amount that you could pay for medical care that is not reimbursed by insurance. Out-of-pocket costs can include deductibles, coinsurance and copayments for covered services. After you've reached your out-of-pocket maximum, your insurance plan must pay for all of your covered medical care with no limit.
No. There are many kinds of health insurance plans. Some plans allow you to visit almost any doctor or health care facility. Others limit your choices to a network of doctors and facilities or require you to pay more if you see doctors outside the network.
It is important to understand what each plan covers, the terms of the plan and any limitations before you purchase a plan. The Summary of Benefits and Coverage (SBC) provides information about health plan coverage in a common format so you can easily compare plans.
A single visit to a primary care doctor can cost between $150 and $200. The average cost of a 3-day hospital stay is $30,000. Fixing a broken leg can cost up to $7500. Having health insurance coverage can help protect you from high, unexpected costs like these. People without health coverage are exposed to these costs, which can sometimes lead people without coverage into deep debt or even into bankruptcy.