Health Insurance Marketplaces Offer New Opportunities

By Doyle, Jim | St Louis Post-Dispatch (MO), September 29, 2013 | Go to article overview

Health Insurance Marketplaces Offer New Opportunities


Doyle, Jim, St Louis Post-Dispatch (MO)


Nathan Brown and Allyson Harper of south St. Louis embody the opportunity and uncertainties in the air as new health insurance marketplaces open for business.

"I've got to get something," said Brown, 23, who drives a truck for a local thrift center that does not provide health insurance to all employees.

Starting on Tuesday, the Affordable Care Act's open enrollment period begins across the United States for new state- and federal- run online marketplaces. The marketplaces, also known as exchanges, will present millions of consumers with various coverage options.

The new law requires most adults to have health insurance beginning in 2014. Those without coverage will be penalized by the Internal Revenue Service. But the penalties initially will be small, and folks have until the end of March 2014 to obtain insurance.

Individuals and families are going to soon face numerous decisions that will shape the quality of health care they have access to in 2014 and beyond.

Brown, like many young men, is in good health. But a recent spider bite hospitalized him for three days reminding him that he's not invincible and can suddenly be hit with huge medical bills.

Harper, 22, is already covered by her mother's health insurance policy thanks to a provision in the Affordable Care Act that obligated large group health plans to maintain coverage for dependents up to age 26.

Like many others, the young couple has a vague notion that something is about to happen that could affect Brown's chances of obtaining affordable health insurance. But they know few specifics about the health policies or tax subsidies that will soon be available.

But twenty-somethings aren't the only individuals who may find opportunities on the new marketplaces in Missouri, Illinois and other states.

Early retirees, who have not yet reached age 65 when the federal Medicare program will start paying for most health care costs, may also find affordable plans and possible tax subsidies on the exchange or not, depending on their economic circumstances.

Self-employed individuals, and those who work for small businesses that do not offer health insurance to their employees, may also find relief. Or, they may find better opportunities on the open market, depending on an exchange's mix of insurers and products.

Families with children who've had trouble finding an affordable health insurance plan may look to the exchange for help. Depending on their specific circumstances, they may or may not find better deals there.

"There's not going to be a bad policy. Everything's covered," said Vincent Blair, a Webster Groves-based health insurance broker. "Now's the time you need to know: What is your financial risk? You really need to become educated on the out-of-pocket numbers: the deductibles, the co-insurance and the stop-loss (out-of-pocket limit) of your policy."

UNCERTAINTY

Still, many people at the bottom of the economic ladder may find themselves out of luck, at least on the western side of the Mississippi River.

More specifically, some Missourians who are unemployed or have low-income, part-time jobs are currently caught in a gap. They are not enrolled in Medicaid, the joint federal-state health care program for the poor, yet they earn too little income to receive tax subsidies on Missouri's federal-run health exchange.

For the most part, individuals who are already covered under large group health plans will not be lured by policies sold on the exchange. But individuals who receive health benefits through their employer and who pay high monthly premiums for coverage of their spouse or children may look to the exchange for opportunities to reduce their costs.

The new law was designed in part to help consumers find reasonably priced health insurance. But as the exchanges open, insurance brokers as well as consumers and government bureaucrats seem awash in uncertainty.

The U. …

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Health Insurance Marketplaces Offer New Opportunities
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