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All posts by Dan Whalen,
Providence, RI (resume)

Sunday, October 13, 2013

Healthcare exchanges (onlne marketplaces)

For those of you who live under a rock, one of Obamacare's major provisions - the individual mandate - just kicked in October 1st.

Ok, so what is the individual mandate?  Simple.  Each and every one of us, all Americans are now responsible for getting ourselves health insurance.  All individuals have been mandated to do so.


Where to go for insurance

How are you getting insurance?  That part is up to you.  But here's your major options:
  1. If you're over 65, enroll in Medicare, the govt run health insurance for the elderly.  There's 49 million seniors getting their healthcare this way already, at little or no cost to the individual.

    Medicare is nothing new, it has existed in one form or another since 1965.  (Side note: some people under 65 with severe disabilities also may be eligible for Medicare insurance).

  2. If you haven't quite yet hit your Golden Girls years, your next best hope is "employer sponsored health insurance."  There's 149 million American's who already get their healthcare this way. 

    SPONSORED is the key word here.  Its pretty rare for an employer to pick up the entire tab for their employees' insurance.  For example, I'm a 29 year old male in good health, unmarried, no kids.  The company I work for pays about half of the cost of my health insurance, but I still pay about $200 a month.

  3. If you aren't a senior citizen and you're not working, you could try to apply for Medicaid.  Medicaid (also started in 1965) is a govt run health insurance for those living in poverty that, like Medicare, has no cost to the individual.

    The only requirement to get Medicare is being 65. Medicaid is not so easy to get.  There's an application process, and interview, a caseworker assigned to you - not everyone who applies is accepted.

    Medicaid also differs from Medicare in that Medicare is paid for by the federal govt, and Medicaid is half funded by the states, and half by the fed. In exchange for the cash, the fed grants the states some say over how Medicaid will operate in their state, and who can enroll.

    There's another Obamacare provision kicking in soon that would require the states to loosen their restrictions on which of their citizens can enroll in Medicaid.  Of course, that means more people will enroll, meaning new expenses for the states.

  4. You're under 65 and your state turned down your Medicaid application.  You're employer either offers no insurance, or offers crappy insurance, or expensive or insurance, or insurance you just don't like.  Where can you turn?

    Before October 1st, 2013, the answer would have been 'nowhere' - you were one of the 48 million Americans with no health insurance.  But starting Oct 1st, yet another provision of Obamacare rolled out, the "exchanges" or "online marketplaces."  These are websites open to any one, where you can shop for, compare, and buy insurance.

    Plans purchased from this site are supposed to cost about the same as employer sponsored insurance.  My employer and I both kick in $200 a month for my insurance, remember?  The hope would be that the uninsured version of me (29 year old, unmarried, male New Yorker with no kids) could get insurance for $200 a month off of the online site.

So what am I required to do?

You are responsible for ensuring that you are insured.  There's a soft deadline of Jan 1st, but in reality you have until the end of March.  If you aren't insured by then, you'll have to pay a fine.  This year, the fines are $95, or 1% of your taxable yearly income, but increase yearly from here on out.

So you probably want to get yourself sorted out now.  The earlier the better, you know?  Visit Healthcare.gov, scroll down, select you're home state and see what insurance would cost you.

Remember, the online marketplaces are open to everyone.  Even if you already have insurance, there's no reason not to check it out, and see if you can find a plan that's cheaper, or better fits your needs

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