Confused about the exchange? Here's a guide to buying health insurance

Open enrollment in the health insurance exchange started last week, kicking off the now-annual exercise in confusion for 2016.

The Topeka Capital-Journal compiled this basic guide to the exchange and health insurance requirements for 2016.

People who want their coverage to start by Jan. 1 need to sign up by Dec. 15, though the final date to sign up is Jan. 31. Some people will be able to sign up later if they have a "qualifying event," such as having a baby, losing a job or aging off their parents' insurance plans, but most will be out of luck if they decide they want insurance later. People who have insurance through work or a government program are covered and don't have to do anything else.

The fine for not having insurance will rise to 2.5 percent of household income or $695 per adult and $348 per child, whichever is higher. It had been 2 percent of income or $325 per adult and $163 per child this year. The price of the benchmark plan rose 16.1 percent compared with last year, though costs can vary considerably.

Julie Koenig, a navigator with Shawnee County Health Agency, said the enrollment process may be simpler this year. People who want to sign up won't have to answer as many separate questions, and the information to determine whether a person is eligible for Medicaid now includes Kansas-specific provisions, she said.

Koenig advised people looking to sign up to allow 90 minutes, though people who have done it before have been able to finish in 40 minutes. She said she has seen a number of people who enrolled last year coming back for help re-enrolling, but isn't sure how many new applicants to expect.

To reduce frustrations, people who want to sign up should have the following information handy:

- Names, Social Security numbers, birth dates and addresses for everyone you want to cover in your household.

- Immigration documents, if relevant.

- Employer and income tax forms, such as your W-2.

- Policy numbers and plan ID for any current health insurance plans covering you or family members.

- If your or your spouse's employer offers insurance, but you opt not to purchase it, a completed employer coverage form, found at: www.healthcare.gov/downloads/employer-coverage-tool.pdf.

- Your household's estimated 2016 income.

Income is particularly important because some people may qualify for two types of assistance to lower their costs based on financial need, Koenig said. People earning between 100 percent and 400 percent of the federal poverty line can qualify for tax credits to reduce the cost of their premiums, she said, and people earning between 100 percent and 250 percent also may get a form of cost- sharing that is applied toward deductibles and copays.

Kara Taylor, who is a certified application counselor in Topeka, said this year brought some changes, particularly to specific populations such as people who have a disability and limited coverage through Medicaid. She said she specializes in difficult cases, and had about one of those each week during open enrollment last year.

"I don't think we're going to see as many this year," she said. "The first year, it seemed like every case was difficult."

Prospective buyers can filter plans by their premium or deductibles, or by their "metal level," Koenig said. The plans are ranked as bronze, silver, gold or platinum, with higher premiums at the upper end of the scale, but lower out-of-pocket costs. They also can check if a doctor or hospital is in a certain plan's network, she said.

Taylor also advised people to check whether their prescriptions are covered under a plan they are thinking about purchasing. They also want to weigh whether they would be better off paying less in premiums and taking their chances on an expected bill, as a healthier person might, or whether they want to pay less out of pocket when they use services, she said.

"For people who have more medical needs, it's probably better for them to pay the higher premium," she said.

The following agencies will offer assistance signing up through the exchange:

- Shawnee County Health Agency, (785) 251-2136. It also will hold a special event at the Topeka and Shawnee County Library, 1515 S.W. 10th, from 9 a.m. to 7 p.m. on Dec. 8.

- Stormont-Vail HealthCare, for hospitalized patients only.

- St. Francis Health, (785) 270-7622. Certified applications counselors are available 8 a.m. to 4:30 p.m. weekdays. People seeking help don't have to be St. Francis patients.

People who don't have insurance through work or a program like Medicare don't have to purchase their coverage through the exchange, though they lose access to tax credits if they buy an individual non- exchange plan. Teri Boyd, owner of ABK Insurance, said agents who are licensed to sell health insurance can help people compare the plans available both on and off the exchange. Some people also don't know basic information, such as they can be fined for not having insurance or that they can't be denied coverage based on pre- existing conditions, she said.

"When you go in and look at those plans, there's 30, 40 different plans, and that's confusing even for an insurance person, let alone a layperson," she said.

To sign up through the exchange, visit www.healthcare.gov or call (800) 318-2596.