NOVEMBER 10, 2015
Health Insurance Marketplace, Enrollment Period 2015-16
Most Americans enrolling on Healthcare.gov will receive financial support
Three Rivers Medical Center offering free application assistance
“Open enrollment”—the annual three-month period during which Americans can comparison shop and purchase healthcare coverage on the government’s Health Insurance Marketplace—is in full swing.
According to the U.S. Department of Health & Human Services (HHS), between 11 and 14 million consumers will purchase 2016 coverage through the Marketplace, and most will qualify for financial assistance.
HHS relays that 7 out of 10 returning customers will be able to buy a health plan and pay less than $75 for monthly premiums—which is the monthly fee charged for coverage; eight of 10 will pay less than $100. Those figures are tied to estimates that 80% of individuals re-enrolling will qualify for advanced tax credits based on their projected annual income; newcomers to the 
Marketplace are expected to fall in the same income brackets andreceive similar help.
“If you’re eligible for a tax credit, the government will send money
directly to your insurance company to help pay the premium,” says
Greg Kiser, CEO at Three Rivers. “So for example, instead of
paying the full $350 monthly cost, you might pay $50 or $75 a
month.”
Penalties for not having health insurance increase significantly in
2016 and will be assessed when 2016 federal tax returns are filed.
Fines are $695 per adult, $347.50 per child, and up to $2,085 per
family or 2.5% of family income—whichever is higher.
The penalties are expected to drive many newcomers to the Marketplace, as most individuals must choose between paying a premium and paying a fine.
“Individuals who don’t have insurance or who need to re-enroll have nothing to lose and everything to gain by evaluating their options,” says Kiser. “You may discover you qualify for Medicaid, tax credits or another type of discount. The goal is to find a plan that best matches your specific health needs and finances.”
Three Rivers Medical Center is offering community residents free help with evaluating insurance options and enrolling on the Marketplace. Appointments can be made with certified assisters by calling (606) 638-7494.
The purpose of the Health Insurance Marketplace is to offer all U.S. citizens access to affordable health plans that offer comprehensive benefits.
To help make health insurance affordable, the government uses household income to determine who is eligible for financial assistance. This assistance might include advanced tax credits to help pay for premiums, or discounts on co-pays and deductibles—which are additional costs related to specific healthcare purchases.
Some of the mandatory benefits included in all Marketplace plans include doctor visits, prescription drugs, hospital and emergency department care, lab services, pediatric care, and free preventive and wellness services. Coverage cannot be denied for individuals with a pre-existing health condition.
“If you are eligible for health insurance but do not purchase coverage, not only will you pay a penalty when filing your tax return, but you will also lose out on financial help with your healthcare expenses throughout the year,” says Kiser. “Our assisters can help you shop the Marketplace to find a plan that meets your needs.”
