BY DAVE HELLING
The Kansas City Star
Actually, parts of it have been with us for years. But one of the most important mechanisms in the law, the health care marketplaces, open for business Tuesday.
For Americans who get health insurance at work, the day will likely pass without notice. But for hundreds of thousands of Kansans and Missourians who lack any health coverage — and for thousands who might want to take advantage of available federal subsidies — the marketplace will be a one-stop, computer-based store to see what insurance is available and how much it will cost.
If you like what you see, you can buy it.
A reminder: Almost everyone must have health insurance by the start of next year or pay a tax penalty. So if you don’t have coverage, it’s time to go shopping, and the marketplace is one way to get it done.
It will be somewhat complicated — trickier than buying an online book, but less than filing a tax return. It should take up to half an hour, more if the computer is slow. Give yourself time.
Federal officials say sign-up should not be affected by a government shutdown. But you don’t have to sign up Tuesday. In fact, some experts suggest you wait a week or two and avoid the rush.
In Kansas and Missouri, the marketplace will be found atHealthCare.gov. Other important websites and phone numbers are listed later.
Here are some other common questions about the new health care system:
What’s a health insurance marketplace?
It’s a computerized list of private health insurance policies that meet certain minimum federal standards. Consumers can go to the marketplace, compare those policies and their cost, learn if they qualify for any subsidies, pick a policy and enroll.
Do I have to use the marketplace?
No. If you want to buy health coverage outside the marketplace, you can. In some cases, it may be the cheaper option.
If you have insurance at work or through a retirement plan, or use Medicare, Medicaid (MO HealthNet or KanCare), or are enrolled with the Veterans Administration, you don’t need to use the marketplace.
The marketplace is intended for individuals without coverage, or with substandard policies.
You must use the marketplace, though, if you want any federal subsidies that may pay some of the cost of a policy.
Do I have to buy insurance Tuesday?
No. The marketplace enrollment period opens Oct. 1, but you can buy insurance through the marketplace anytime through March 31, 2014.
However, with just a few exceptions, you must obtain health insurance by Dec. 15, 2013, or face a tax penalty. The penalty would be paid with the tax return you file in April 2015.
Coverage purchased through the marketplace by Dec. 15 becomes effective Jan. 1, 2014.
Do I have to keep my marketplace insurance forever?
No. There will be another, shorter open enrollment in 2014, and every year after that. You can change policies then if you want.
Under certain circumstances, you can sign up for coverage after the March deadline as well. If you lose your coverage at work, for example, or get married, you can go on the exchange and enroll.
I have an illness and have been turned down for coverage. Can I get coverage in the marketplace?
Yes. Insurers cannot deny coverage based on pre-existing health conditions.
What do I need to know before I apply?
You’ll need to know if you want coverage for just yourself or members of your family. You’ll need a rough idea of your income for next year. You’ll be asked your state of residence, and you may be asked if you smoke.
You’ll also need your Social Security number, and if you plan to buy a policy, a credit or debit card may be helpful.
How many insurance options will I have?
The companies in the marketplace can offer several levels of coverage — from bronze, the cheapest, to silver, gold and platinum, the most expensive. There may be different options within each level as well.
Not every insurer will offer policies on all four levels.
Lower-cost plans like bronze and silver will offer fewer benefits and require you to pay more out of your pocket when you actually seek health care. Higher-cost plans like gold and platinum will cover more but cost you more each month in premiums.
So you may want to have a rough idea of how much health care you expect to need in 2014. That will make it easier to compare policies.
All plans offered in the marketplace must offer a basic level of coverage, including some medical services that will be free to you.
I can’t afford the premium. What should I do?
You may qualify for federal tax credits to help pay part of the monthly premium cost. The subsidy begins for households with income at or above 100 percent of the poverty level — that’s $11,490 annually for an individual this year, $23,550 for a family of four.
The subsidy can be substantial. A St. Louis family of four with $50,000 in income will pay just $32 a month, officials predict, for the cheapest bronze policy after the tax credit is applied.
The government hasn’t published the cost for a Kansas City family, but it’s likely to be similar. Remember, though, that cheap bronze policy won’t cover as much as a more expensive option.
As you earn more, the tax credit declines. If you earn more than 400 percent of the poverty level — that’s $94,200 for a family of four this year — you won’t qualify for any credit.
You won’t have to wait for a check to get the subsidy. When you sign up through the marketplace, your subsidy will be calculated and applied to your premium.
If you’re too poor to file a tax return, you won’t be penalized for not having insurance.
I don’t have a bank account. How will I pay the premium?
This is actually more complicated than it looks — many people don’t use a bank. Insurers in the marketplace will accept checks, money orders, bank transfers, prepaid debit cards and automatic credit card deductions.
You must pay the premiums you agree to, or you could lose your coverage.
I make less than the poverty level. Can I use the marketplace?
Yes, but you won’t qualify for the subsidy. You’re in a tough spot.
If you are very poor and have children, you may qualify for Medicaid, the state-based health insurance program for the poor, or CHIP for the kids. When you enter information in the marketplace, it’s supposed to tell you whether you might qualify for those programs.
If you earn too much for Medicaid, you can still buy insurance — but you won’t get any subsidy for the premium unless you earn at least 100 percent of the poverty level.
Some states have expanded Medicaid to cover consumers in this gap, but Kansas and Missouri aren’t among them. So someone earning $10,000 a year in those states will likely pay twice as much for the same policy as someone earning $25,000.
The government has said it won’t penalize consumers in the gap if they choose not to buy.
I’m in college. Can I use the marketplace?
Yes. Some consumers under age 30 may be able to obtain low-cost policies that pay benefits only in the event of a catastrophic health problem.
Young adults can stay on their parents’ policy until age 26.
I don’t have a computer, and I don’t know how to use one. Can I get help?
Yes. You can discuss your needs, and enroll by phone, at 1-800-318-2596. Hearing-impaired callers with TTY/TTD technology should call 855-889-4325.
The Shepherd Centers in Kansas City — at 5200 Oak and 3501 Campbell — will have on-site experts who can help walk you through the process, although as of Friday they had not received all the needed paperwork.
Call the centers at 816-753-7039 or 816-444-1121 for more information. Appointments are recommended.
The advice is free. But helpers can’t tell you which policy to buy.
Many health care providers, community health centers and other groups say they’ll provide guidance for patients. If in doubt, call your doctor.
Blue Cross and Blue Shield of Kansas City is one of the companies offering coverage in the marketplace. They’ll answer questions at 1-800-645-8356. Other private insurance companies and independent brokers may be able to help.
You may also use computers at public libraries.
Here is a calculator to help determine the cost of your health insurance:
To reach Dave Helling, call 816-234-4656 or send email to firstname.lastname@example.org.