Health care exhanges set up shop [Telegraph-Herald (Dubuque, IA)]

how to get enrolled Visit healthcare.gov or call 800-318-2596. information sessions in Dubuque Individuals and small-business owners can learn about Iowa's new insurance marketplace and how to purchase health insurance in a pair of information sessions scheduled for Tuesday, the day the markets open. Iowa Insurance Commissioner Nick Gerhart and David Lyons, CEO of CoOportunity Health, one of two insurance companies offering plans statewide on the new market, will attend the sessions hosted by Iowa legislators Pam Jochum and Chuck Isenhart, both Dubuque Democrats. A meeting to discuss small-business options will be held at 1:30 p.m. in Room 200 of Northeast Iowa Community College's Town Clock Center campus. A meeting to discuss options for individuals and families will be held at 6:30 p.m. in the Roosevelt Middle School auditorium at 2001 Radford Road.The new federal health care law mandates that all individuals carry health insurance.

To help people acquire coverage, the law created online marketplaces from which private insurance can be purchased, in some cases with financial aid.

Those marketplaces open Tuesday.

Here are a few basic things people need to know about the new health insurance marketplaces as one of the key elements of the new health care law rolls out:

BASIC BACKGROUND

Under the new health care law, all Americans must have insurance or pay a penalty on their taxes. That penalty will be $95, or 1 percent of one's personal income, whichever is higher. That penalty will increase each year.

The rule goes into effect Jan. 1, 2014.

A similar mandate that all businesses with 50 or more full-time equivalent employees must offer health insurance was delayed to Jan. 1, 2015.

To assist those who do not have health insurance, the law created the marketplaces, where individuals and small businesses may shop from among competing private health insurance plans. Multiple insurance companies are offering plans in most areas. Those plans must cover a mandatory baseline of services and are divided into multiple tiers; some have higher deductibles with lower out-of- pocket costs, and others vice-versa.

Some low-income individuals who do not qualify for Medicaid will be eligible for financial assistance on their premiums.

TIMELINE

Individuals can set up an account and start shopping for insurance right now at healthcare.gov. Open enrollment for 2014 begins Tuesday and runs through March 31, 2014. For coverage to kick in Jan. 1, however, one must be enrolled by Dec. 15 of this year.

Open enrollment for 2015 runs Oct. 15, 2014, through Dec. 7, 2014.

You can enroll for coverage outside of the open-enrollment windows only in the case of a qualifying event such as job loss, a birth, marriage or divorce.

WHO IT'S FOR/NOT FOR

Anyone may purchase insurance from the marketplace, even those who already have it, either on their own or through an employer.

But the marketplace figures to be especially valuable to those who do not already have health insurance.

Those who are on Medicare or Medicaid, or who already have insurance and are happy with it, are not required to take any action.

David Lyons, founder and CEO of CoOportunity Health, one of two companies offering insurance plans statewide in Iowa, implored anyone interested to at least research their options.

"The most important thing to do is to shop. That's the No. 1 issue people need to know," Lyons said. "There are more choices and there is a greater ability to compare policies than they will have seen in the past.

"Whether they are without insurance now and want to access it or whether they have insurance now and want to look at new options, the most important thing to do is take advantage of the new information and new options and shop."

HOW MUCH IT WILL COST

The No. 1 most-asked question about the new federal health care law, according to a recent Kaiser Health Tracking Poll, has no easy answer.

People who purchase insurance through the exchanges will have a wide variety of plans from which to choose. Factors include age, place of residence and whether shoppers use tobacco products. Furthermore, some people will be eligible for financial aid to bring down the cost.

There is no definitive source of data that shows how marketplace plans compare to health insurance plans already available on the private market. A story published by the nonprofit Kaiser Health News said the "prices for the marketplace plans are likely to be similar to those sold privately."

WHO GETS FINANCIAL AID

People who are not offered insurance by their employer and whose income is less than 400 percent of the federal poverty level - $45,960 for an individual or $94,200 for a family of four, for example - may be eligible for federal tax credits that can be paid directly to the insurer or deducted on the person's tax return.

The tax credits are calculated by subtracting a percentage of household income from the cost of insurance in the marketplace.

WHO CAN HELP

The federal government created navigators to help people gather information on and purchase insurance through the exchanges. Each state has its own navigators.

Some local entities also received federal grants to provide information and outreach, including Crescent Community Health Center in Dubuque.