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November 14, 2022 Newswires
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Five things to know about the health insurance marketplace

Nashville Post (TN)
It's busy season for Aida Whitfield, health care access manager for Family and Children's Service in Nashville. The enrollment window for federal marketplace health insurance opened Nov. 1, and before it closes again on Jan. 15, she and her team of 25 will have helped thousands of Tennesseans get enrolled in health insurance.

"For a lot of people the big jargon of insurance plans and all these little tricky names are kind of scary," Whitfield said. "They want to have someone who can just go through it and explain the question to help them understand what they're completing."

Whitfield and other health care access navigators take short phone calls for troubleshooting and book longer appointments to complete the entire insurance process. During this window, her work is focused on helping people choose between the healthcare.gov offerings. Whitfield sat down with the Post to point out five things to know for this year's enrollment period.

The family glitch is fixed this year, something Whitfield called a "big deal." A previous rule barred families from qualifying for healthcare.gov insurance when one member received coverage from their employer that was considered affordable. It didn't take into consideration how much it would cost for the entire family to be covered — just the employee. That 2013 rule is changed, which will allow a lot more people to be eligible for a tax credit, Whitfield explained.

The window is open longer than it traditionally was. For 2021 and 2020, as well as this year, the window has been extended due to the COVID-19 pandemic. Typically, it would have ended Dec. 15.

Whitfield recommends re-enrolling each year to confirm that the client's income and household size is accurate. It could cost more if the income is overestimated.

"We always educate clients to come back and we will screen them again and then see if something, anything changes — income change, household size change or even if their provider changed and we can find a better plan that could accommodate their medical needs," Whitfield said.

While it's on a .gov site, it's not government-sponsored insurance, like TennCare or Medicare.

"It's not government insurance because at the end of it, people get to choose a plan through well-known for-profit health insurance," Whitfield said. "However, the benefit of signing through the marketplace to healthcare.gov is people will be eligible for tax credit based on their income to lower the premiums."

It's not just for people with low income. There are many Tennesseans who fall in the coverage gap, who may have relatively low income, but not low enough to qualify for TennCare. More will fall into the gap when the federal health emergency ends and sets into motion a re-enrollment process for the state-sponsored low-income insurance, which hasn't happened for nearly three years. Even so, Whitfield explained there are still instances where marketplace coverage is more economical than workplace coverage.

"We always want to make sure they're doing the right thing because if they are still in the higher income bracket, it could be that maybe an option for them would probably be best to stay with their employer plan," Whitfield said. "However, for a lot of clients that we assist it has always been a cheaper option than their employer coverage."

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