David Mekeel: What you need to know about the Affordable Care Act marketplace [Reading Eagle, Pa.]

Oct. 29—Open enrollment for the Affordable Care Act health insurance marketplace begins Nov. 1.

The marketplace is a platform that allows people to directly buy health insurance from providers. It was created by the Affordable Care Act of 2010 — often referred to as "Obamacare" — and is meant to help extend health insurance coverage to the millions of previously uninsured Americans.

For Pennsylvanians interested in signing up for a plan, that means a stop to Pennie.

Pennie is the state's health insurance marketplace. While the federal government runs its own marketplace, some states, including Pennsylvania, have created their own versions.

Pennie can accessed at pennie.com. The website is available in English, Spanish, Russian and Mandarin.

Here are some of the basics you need to know if you're considering visiting Pennie to buy health insurance through the marketplace.

Who should use the marketplace?

The marketplace is primarily for people who don't otherwise have access to health coverage.

That means people who do not get health insurance through a job, or who don't qualify for programs such as Children's Health Insurance Program (CHIP), Medicare or Medicaid.

There are some exceptions.

People who are offered health insurance through their employer can get coverage through the marketplace if their job-based insurance doesn't meet minimum standards for affordability and coverage.

For job-based insurance to be deemed "affordable" your share of monthly premiums for the lowest level of the plan for just yourself needs to be less than 9.83% of your household income.

So if you have a household income of $50,000, that means a job-based plan is "affordable" if the cheapest option that only covers the employee has monthly premiums less than $408 per month or $4,900 for the year.

To meet the minimum standard for coverage, a plan must pay at least 60% of total medical costs.

Most job-based insurance meets both of those standards for most people. To find out if your job-based plan does meet the criteria you can have your employer fill out an "Employer Coverage Tool" form that can be found at marketplace.cms.gov/applications-and-forms/employer-coverage-tool.pdf.

Enrollment dates

The open enrollment period to sign up for health insurance through the Affordable Care Act marketplace starts on Nov. 1.

To get coverage that starts on Jan. 1 you must sign up by Dec. 15.

The last day to sign up for 2022 coverage is Jan. 15. People who sign up between Dec. 15 and Jan. 15 will see their coverage start on Feb. 1.

After Jan. 15, you can only sign up for coverage if you qualify for a special enrollment period. You qualify for a special enrollment period if you've experienced certain life events including.

— Losing health coverage.

— Moving.

— Getting married.

— Having a baby.

— Adopting a child.

Depending on the type of life event, you may have up to 60 days before or after the event to enroll in a plan.

For more information on special enrollment periods visit healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period.

How much does it cost?

The plans on the marketplace are offered by private insurance companies and have a range of prices and features.

The cost of insurance through the marketplace for you depends on which plan you choose and your level of income. Plans and prices for 2022 will be available for preview shortly before the open enrollment period begins.

Depending on your household income level, you may qualify for savings on premiums. Or you might qualify for another government health insurance program.

To find out what assistance or savings you qualify for visit enroll.pennie.com/hix/preeligibility#.

You may also qualify for a premium tax credit that lowers your monthly insurance bill or extra savings on out-of-pocket costs like deductibles and copayments.

American Rescue Plan benefits

The federal American Rescue Plan provides all sorts of financial assistance to help overcome the impact of the COVID-19 pandemic.

That includes lowering many people's health insurance premiums for plans bought through the marketplace. The American Rescue Plan increases the amount of financial assistance people can get and also increases the income limit to qualify for assistance.

The lower premiums will remain in effect for all of 2022, and could be extended or made permanent by Congress. Those who qualify for American Rescue Plan assistance will pay no more than 8.5% of their annual income on health insurance premiums.

The reduced premiums apply to any insurance plan available through the marketplace.

The best way to see if you qualify for a reduction is to visit pennie.com and click on the "get covered" button.

How to apply

There are a bunch of different ways you can enroll in a health insurance plan through the marketplace.

The easiest way is visit Pennsylvania's health insurance marketplace at pennie.com and click on the "get covered" button.

Other options include:

— Finding an broker. A broker can offer free guidance and advice, including making recommendations on which plan you should buy. To find a local broker visit enroll.pennie.com/hix/broker/search/individual.

— Finding an assister. An assister can help you understand the options available for you or your family. To fins a local assister visit enroll.pennie.com/hix/entity/locateassister/searchentities.

— If you'd rather have a broker contact you, you can provide some information about yourself at localhelp.healthcare.gov/#/get-contacted.

— Using a certified enrollment partner's website. To find one visit healthcare.gov/direct-enrollment.

— To reach the Pennie customer service center call 1-844-844-8040. The call center is open Monday through Friday from 8 a.m. until 6 p.m.

What you need to apply

There are several pieces of information you'll need to fill out an application in the marketplace. They include:

— Basic information about yourself including your name, home address, Social Security number and date of birth.

— Information about each person in your household and about each person applying for coverage, including names, Social Security numbers, date of birth.

— If being helped by a professional, they'll need to enter their information, too.

— Immigration documents.

— Information about your federal income taxes.

— Information about your employer and income, as well as about the employers and incomes of members of your household.

— An estimate of your household income.

— Information about any health insurance coverage that any other members of your household have.

For a full checklist of everything you'll need visit healthcare.gov/downloads/apply-for-or-renew-coverage.pdf.

Renewing or changing coverage

If you already have an insurance plan that you purchased through the marketplace, Nov. 1 opens up the window for you to renew or change that coverage.

The marketplace and your insurance provider will each send you a notice prior to Nov. 1 that will tell you if your plan is available for 2022, if it is changing in any way and how much it will cost. The notices will also give you information on what to do to compare, change or keep plans.

If you have a 2021 plan through the marketplace and do not receive a notice from your provider by Nov. 1, contact your insurance company.

If you do not receive a notice from the marketplace by Nov. 1, call the call center at 1-844-844-8040.

In most cases, if you do nothing before Dec. 15 you will be automatically re-enrolled in your 2021 plan.

While that can be an easy answer for some, the best way to make sure you're getting the best plan for your needs is to update your information and review your options. You can update your information by logging into your marketplace account at pennie.com.

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