OKPOLICY.ORG
This post is by OK Policy intern Lydia Lapidus. Lydia is a recent graduate from George Washington University’s Elliott School of International Affairs with a concentration in International Politics.
Fall is here, and the Healthcare.gov online marketplace is up and running with options that won’t eat into your pumpkin spice budget. This year’s shortened open enrollment period will span from November 1st to December 15th, 2017, with coverage beginning on January 1st. (Note: Members of a federally-recognized American Indian tribe are exempt from these deadlines and can enroll on HealthCare.gov at any time of the year.)
Whether you need to get insured, switch plans, or re-enroll, here is some information to help.
How do I enroll?
Finding and enrolling in the right health plan can be a complicated process. Fortunately, there are plenty of resources available to help. Residents of Oklahoma can shop around and sign up for 2018 coverage at Healthcare.gov. If you need assistance in understanding your eligibility or finding an affordable plan, check out Healthcare.gov’s Local Help page or visit Get Covered America to find appointments with local navigators near you.
Who can purchase a Marketplace plan?
If you buy your health insurance on your own (rather than through your employer), you can purchase a 2018 Marketplace plan. If you have employer-based insurance, you can buy a Marketplace plan, but you’ll have to pay full price unless your employer-provided insurance doesn’t meet certain standards. If you are low-income, you may qualify for Medicaid — in which case you can’t buy Marketplace insurance, but you can enroll in SoonerCare at any time. If you are ineligible for Medicaid but don’t make enough to qualify for premium subsidies on the Marketplace, you are likely exempt from the tax penalty for being uninsured.
I bought a plan last year. I’m good, right?
If your current plan offers coverage through 2018, you can choose to keep it. You might be renewed automatically into that plan, but it’s worth double-checking. If your current plan isn’t offered for 2018, you will be automatically enrolled in a different plan unless you select a new one. In any case, it’s wise to review your options and update your application to make sure you are getting the coverage you want at the right price.
What about those high premiums?
Yes, premiums have been on the rise. However, for most enrollees, tax credits based on income and the cost of coverage should cover most or all of the cost increase. Last year, 9 out of 10 Oklahoma enrollees received tax credits that brought the average monthly premium down from $550 to just $79. If your income falls between 100% and 400% of the Federal Poverty Line, you qualify for this credit.
What plans are available?
The Marketplace offers tiers of plans that differ in deductible amounts and monthly premiums. The bronze plans generally have the highest deductibles and lowest premiums, while gold plans have low deductibles and high premiums. You can find a breakdown of the plans here. If you’re under 30, you can also get a plan with a higher deductible and lower premiums than the bronze plans.
What’s covered?
All Marketplace insurance plans cover the same essential benefits. These include, but are not limited to: ER services, doctor charges, hospitalization, pregnancy, treatment for all pre-existing conditions, mental health and substance abuse services, lab work, and birth control. Some plans also include dental coverage.
I’m young and healthy. Why should I get insurance?
Nobody plans to get sick or hurt, but bad things happen, even to healthy people. A broken leg can cost $7,500 to treat. Three days in the hospital can cost $30,000. That’s a lot of money to come up with out of your own pocket, and that kind of medical debt can really limit your options. In Oklahoma, people ages 25-34 are more likely to be uninsured than any other group. This is largely due to affordability. Fortunately, many young adults have incomes that qualify for cost-sharing subsidies and premium tax credits. You can check your eligibility and savings based on income here. If you want more help getting insured, consider making an appointment with a navigator to find the right plan for you.
What’s the bottom line?
For thousands of Oklahomans, open enrollment is the best time to improve both their physical and financial health. When you buy health insurance, you are helping yourself avoid the threat of massive debt from potential medical bills. You’ll have access to care when you need it, and can receive preventative services to stay healthy. There are affordable options and resources to help you find them. It’s worth taking a look!
