What’s it like: To sign up for health insurance through the federal marketplace

Feb. 16--What is the health insurance marketplace?

The health insurance marketplace was created through the Affordable Care Act, sometimes referred to as "Obamacare." The marketplace is, in part, a website where health insurance companies list the plans they will offer under the marketplace guidelines.

Plans through the marketplace are private health insurance plans. In Oklahoma, you generally have the option of buying a plan through one of five companies: Blue Cross Blue Shield of Oklahoma, Coventry Health Care of Kansas, GlobalHealth, Aetna or CommunityCare.

These plans include health insurance coverage for "essential benefits," which includes emergency services, maternity and newborn care, mental health or substance use disorder services, prescription drugs and laboratory service. Plans also cover pre-existing conditions and preventive care.

How do you sign up?

You can look at plans available through the marketplace by going to HealthCare.gov. You can also enroll in a plan by calling (800) 318-2596, or (855) 889-4325 for text telephone (TTY).

The website has a history of being buggy, although federal officials have said the issues that the website had when it initially opened in October have largely been resolved. When HealthCare.gov initially launched, many users experienced long wait times and had frustrations with the website crashing.

Who can sign up for coverage?

To be eligible for coverage, you must live in the U.S., be a citizen or national or be lawfully present. You cannot enroll if you're in prison.

Depending on your income level, you might qualify for a discount on your health insurance plan, known as a subsidy or premium tax credit. These credits are generally available to people who made a household income between 100 percent and 400 percent of the federal poverty level. While enrolling, you'll be asked about your income and likely told whether you qualify for these benefits.

In Oklahoma, if you earn less than 100 percent of the federal poverty level, you generally do not qualify for a subsidy. Oklahoma has not expanded its Medicaid program, which was one of the measures of the Affordable Care Act. If Medicaid were expanded, it would likely include adults who live in this poverty level.

When is the deadline to enroll?

A process known as "open enrollment" ends March 31. Open enrollment is the time period when you can sign up or change your health insurance plan. After March 31, you won't be able to sign up for a plan unless you have a "qualifying life event," such as you get married, divorced, have a baby or adopt a child, or you lose your job.

What plans are available?

You can buy a bronze, silver, gold or platinum plan, but keep in mind that cost is not the only factor you should consider.

Bronze plans will have the highest deductibles and other cost sharing. For example, a bronze plan might have a much higher deductible but be available for a lower cost than a plan with a lower deductible. A deductible is the amount of money you have to pay for certain services before your health insurance company begins to pay for those services.

Platinum plans generally have the lowest deductibles, co-pays and other cost sharing. In general, plans with lower cost sharing will have higher premiums, and vice versa.

You might also be eligible to buy a catastrophic plan, which has the highest deductible among marketplace plans. It's generally available only for adults up to age 30, and for older people who can't find any other marketplace policy that costs less than 8 percent of their income.

There are several differences among plans. It's best to contact insurers and ask specific questions about coverage details. For example, a plan's network might not include your primary care doctor.

What resources are available to help you enroll?

In Oklahoma, dial 211 to be connected with a marketplace navigator, someone who's trained in answering questions about the process of buying insurance.

By dialing 211, you can also find out if there's a place close to your home where you can go in person to talk with someone about plans and coverage.

You can also talk with a licensed insurance agent or broker. Also, insurance companies will answer questions about the plans they offer.

In Oklahoma, you can also call the Oklahoma Primary Care Association at 601-9270 to find out more about finding resources to help you enroll in the plan that might work best for you.

Source: Patricia Christensen, certified marketplace navigator at Oklahoma Primary Care Association; HealthCare.gov; Kaiser Family Foundation.

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