When it comes to choosing a healthcare plan that’s right for you and your family, it can be a confusing and daunting task. If you are not offered insurance by your current employer, you may be looking at options like the Health Insurance Marketplace, which was created as a result of the Affordable Care Act (ACA). When choosing a plan, a variety of questions may arise before selecting one: What plans does my healthcare provider accept? Where can I go if I get hurt? What is the best and most affordable option for me and my family?
When selecting a plan and getting started, there are several steps to keep in mind:
1. Open enrollment is from November 15, 2014 – February 15, 2015. (Coverage begins as early as January 1, 2015 for individuals who enroll by December 15, 2014.)
2. If you currently have coverage through the Exchange/Marketplace, you will need to re-enroll between November 15 and December 15 to have coverage by January 1, 2015.
3. If you enrolled last year, re-enroll to see you qualify for lower costs premiums that may better fit your needs and budget for the new year.
4. Follow up with your local healthcare provider and physicians and find out what plans they accept. Decatur County Memorial Hospital (DCMH) currently accepts Anthem Pathway, UnitedHealthcare Choice and locally-based SIHO plans.
5. Go to www.healthcare.gov and navigate/review your options available. Remember to select options that are available and accepted through your local healthcare provider. Should you need assistance signing up, you may contact a local insurance agent to get started.
Individuals or families who are already insured by their current employer do not need to sign up for coverage on the Health Insurance Marketplace. Uninsured individuals who choose to forgo the process of signing up and choosing a healthcare plan will be required to pay a penalty fee according to the Affordable Care Act. The fee for not having health coverage is calculated one of two ways. If you or your dependents don’t have insurance that qualifies as minimal essential coverage you’ll pay either a percentage of your household income or a flat fee, whichever is higher.
If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:
• 2 percent of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
• $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
The penalty increases every year. In 2016 it will be 2 1/2 percent of your income or $695 per person. After that, it’s adjusted for inflation.
The Health Insurance Marketplace, while slightly confusing, is the best choice available for people who are uninsured. Upon finding networks supported by your local healthcare providers, the confusion narrows and healthcare becomes much more attainable.
A reminder that your local hospital, Decatur County Memorial Hospital can be available as a resource for questions by calling (812) 663-1300 or visiting dcmh.net/Marketplace to see a list of plans accepted. DCMH alongside Susan Doerflinger Burkhart, SIHO and UnitedHealthcare have also scheduled a series of “Insurance-101” events to help educate community members on the different insurance terms, premium subsidies and tax credits available through the Marketplace, how to select a plan, the difference between in and out of network plans and more. December sessions are listed below:
• December 1
5:00 – 7:00 p.m.
DCMH Conference Rm. D
• December 10
6:00 – 8:00 p.m.
Westport Community Building
Again, DCMH currently accepts plans listed under the Anthem Pathway, UnitedHealthcare Choice and locally-based SIHO networks. One may also check the insurance providers’ webpages for additional information as well, at www.anthem.com, www.uhc.com, or www.siho.org. Choose a plan where you’re insured close to home and with a hospital and doctors that care. For more information visit www.dcmh.net/Marketplace or call (812) 663-1300.