THE BLOG

Health Care Marketplaces: A Drumroll, Please

09/23/2013 01:49 pm ET | Updated Nov 23, 2013

They say that when raising children, the days are long but the years are short. The same can be said about the rollout of the Affordable Care Act.

On the one hand, it's hard to believe that the centerpiece of the plan -- the health insurance mandate and the widespread availability of affordable health insurance -- is finally about to become a reality. At times since the law's enactment in March 2010, the road to launch has seemed very long indeed, and strewn with litigation, misinformation, and considerable legislative sound and fury signifying nothing.

On the other hand, for those of us working with federal, state and local policymakers and advocates to make sure everything works the way it is supposed to for the more than 48 million people without health insurance, the last few years have flown by. And now we are just days away from October 1. That's when Health Insurance Marketplaces across the country will open for business, offering coverage options for individuals, families, and small businesses that will generally begin January 1, 2014.

Unfortunately, it seems that this is still news to many. A recent survey found that as of mid-August, four out of 10 individuals were unaware that the ACA is still the law. Those who stand to benefit from it the most -- those earning less than $30,000 a year and those under 30 -- are even less likely to know.

Sure, if you and everyone you know already have employer-sponsored health insurance that doesn't set you back too much out of pocket, you can stop reading now.

But if you pay for your own insurance, or don't have insurance, or know someone who may be struggling in this area, please read on. It's time to start paying attention.

Here are some basic facts that you can share.

What happens on October 1? On October 1, Health Insurance Marketplaces in every state will be available, either in physical locations or on line, to help uninsured and under-insured people identify the best health insurance options for them from a slate of plans.

Is this government-run insurance? No. The plans offered through the Marketplaces are sponsored and managed by private companies like Anthem/Blue Cross and Aetna. The Marketplace merely helps people evaluate and manage their plans and determine their eligibility for different programs. Some people who have a low income or special health needs may also qualify for Medicaid, an existing state-federal health care program that many states are expanding under the ACA to serve a greater portion of their populations.

What's the big deal about these new insurance plans? Lower prices and higher quality. All states will offer Bronze, Silver, Gold, and Platinum plans (the more expensive the plan, the lower the out-of-pocket cost down the road and vice versa). They all share a number of benefits:

  • Because they pool risk among a large number of people, the plans should cost less--in some cases much less--than those available now on the individual market. Until the doors open on October 1, you can get a rough estimate here or state-specific information here.
  • Every plan must cover 10 "essential health benefits" such as emergency services, mental health care, maternal and newborn care, and prescription drugs.
  • The plans will not be allowed to reject applicants on the basis of a pre-existing condition, and there will be no lifetime cap or annual limit on coverage for essential health benefits.

Do I have to get insurance? Most likely, yes. By January 1, 2014, most people in the country will be required to have health insurance or pay a tax. (There are some exceptions for groups like low-income people who do not have to file tax returns, undocumented immigrants, and members of Native American tribes.)

What if I can't afford insurance? Help is available. Under the ACA, individuals and families can receive a subsidy to help cover their insurance premium if their income is under 400 percent of the federal poverty level (in 2013, roughly $45,000 for an individual or $94,000 for a family of four). Navigators and others connected to the Marketplaces can help you understand your options, or you can get a preliminary sense of what you might qualify for through this subsidy calculator offered by the Kaiser Family Foundation.

Where can I find more information? Individuals will be able to get plan details for their states starting October 1 here, and small businesses can learn more here. In the meantime, learn more about the promise of the ACA here.

Because the first step to getting and staying healthy? It's getting educated.