COLUMBIA, SC — Here are 10 things you need to know about Mondays Health Insurance Marketplace deadline:
1. Its only sort of a deadline. Anyone who has started the registration process online or by phone but isnt able to finish by March 31 will be given time to complete the process after March 31. The Centers for Medicaid and Medicare Services compare it to voting. If youre in line at 7 p.m. on election day, you get to vote. The time limit for returning to complete registration is squishy, though CMS says it must be done quickly.
2. If youre 65 or older, you qualify for Medicare and dont need to worry about the Health Insurance Marketplace. If you have health insurance through your job, you dont need to worry about it. If you have private health insurance that youre happy with, you dont need to worry about it.
3. If you earn less than $11,500 annually you dont qualify for tax subsidies that make the Health Insurance Marketplace policies more affordable. And without those subsidies, you wont be able to afford a policy. Youre in a gap created when South Carolina leaders turned down the federal expansion of Medicaid.
4. Most people are required by the Affordable Care Act to have health insurance this year. The penalty for not having insurance is $95 per person or 1 percent of annual income, whichever is greater. Itll come due when you file your 2014 taxes in 2015.
5. A lot of people in South Carolina, however, will be exempt from the penalty. Anyone making less than $15,300 is exempt. So are Native Americans, illegal immigrants and some religious groups that refuse health care. Of course, people 65 and older dont need to worry either (See No. 2.)
6. If you sign up for a policy on the Health Insurance Marketplace, youll have multiple choices. There are four companies on the federal marketplace in South Carolina BlueCross BlueShield of South Carolina, BlueChoice HealthPlan, Consumers Choice, Coventry One. They offer policies at three levels bronze, silver and gold. Generally, premiums are lowest at bronze and highest at gold, while benefits are best at gold and worst at bronze. Because of the way the tax subsidies are structured, silver plans often are the best value.
7. The federal government gave grants to local groups to provide navigators to help people through the process. Youll find navigators at most of the registration events in these final days. You also can register on your own online at healthcare.gov, through the insurance companies selling policies or through a private insurance broker.
8. You need to understand the nuances of physician networks, deductibles and out-of-pocket expenses. The Q&A at healthcare.gov does a good job of explaining those. If you read those explanations and are still confused, you probably need to get the help of the folks mentioned in No. 7.
9. People who have used the policies in the first three months of the year have had the most problems with physician networks. If you have a preferred primary care physician, call that office to make sure they accept Health Insurance Marketplace policies. Dont rely entirely on lists on the insurance company websites. Also, if you have a preferred hospital, make sure they are on your policys network. Many hospitals are on only one or two of the policy networks.
10. If you are younger than 30, you are eligible for a low-cost catastrophic plan. Its not a bad deal if youre generally healthy. You get three free primary care visits a year, and it protects you from a long-term hospital stay bankrupting you. But you dont get much else.