In Spanish l Americans are gearing up for the first open enrollment season of the Affordable Care Act, the federal health care law known as Obamacare, beginning Oct. 1.
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Despite a barrage of articles, advertisements and public service announcements, there's still a lot to learn about open enrollment in the Health Insurance Marketplace and whether it affects open enrollment for other types of insurance, including Medicare, existing employer-sponsored plans and individual insurance plans.
Here are answers to several frequently asked questions about health insurance.
What is open enrollment?
It's the window during which eligible individuals can enroll in a group health insurance plan or change their existing coverage.
What happens during open enrollment?
You can choose health insurance that best meets your needs. This includes initiating or dropping coverage, or picking among such options as monthly premium costs, copayments, annual deductibles and prescription drug coverage. Participating insurance companies can't turn you away or charge you more because you have an illness or medical condition.
How often is open enrollment held?
Once a year, typically. If you have a qualifying "life event" (you get married or divorced or adopt a child, for example), you may be able to change your insurance coverage outside of the open enrollment period.
Does everybody have to do something during the Health Insurance Marketplace open enrollment period?
No. Most people with health insurance don't have to do anything. This includes people who have Medicare, Medicaid and, for the most part, those who have employer-sponsored insurance or their own individual policies. Also, people with very low incomes and members of federally recognized Indian tribes don't have to do anything.
Who must apply for coverage through the marketplace?
In general, Americans who don't have health insurance that meets certain government standards must get coverage during this open enrollment period. Those who don't may face financial penalties.
When does open enrollment in the marketplace start?
This first time, it starts on Oct. 1, 2013, and ends on March 31, 2014. If you enroll by Dec. 23, your coverage will begin Jan. 1, 2014.
What about in future years?
Beginning in 2014, the marketplace open enrollment will coincide with Medicare open enrollment: Oct. 15 through Dec. 7.
Next page: What can you do at the marketplace? »
What can I do at the marketplace?
You shop for and fill out an application to buy a health insurance plan. The marketplace is run by either your state or the federal government, depending where you live. You can find out who runs the marketplace in your state online at Healthcare.gov or by calling 800-318-2596. You'll be able to compare prices, benefits and premiums of various insurance plans that meet the law's requirements and find out if you qualify for financial help.
What if I need help to apply?
Telephone (800-318-2596) and online-chat help is available 24/7 to assist you in completing your application.
Is online the only way I can apply for coverage?
No. You can also enroll by mail or in person at the marketplace in your state or through an insurance broker. For details call 800-318-2596.
What if I think I might be eligible for Medicaid?
The marketplace will also tell you if you qualify for free or low-cost coverage through Medicaid and let your state's Medicaid agency know so your coverage can start as soon as possible.
Can I switch from my private individual plan to one offered through the marketplace?
If your private individual plan ends before March 31, 2014, you can use the marketplace during open enrollment to replace it, with coverage beginning as early as Jan. 1, 2014. And if your current individual plan doesn't meet the law's minimum standards, you might be required to shop in the marketplace. Either way, be sure to check what financial help might be available to you for premiums and other out-of-pocket costs. If your plan ends after March 31, you may qualify for a special enrollment period that lets you shop the marketplace for a new plan. Contact your current health insurance provider for details.
When is open enrollment for employer-sponsored plans?
There's no set window, but it often opens in mid- to late fall.
Do existing employer-sponsored and individual plans have to provide the same benefits offered in plans available through the marketplace?
Yes and no. The health care law requires so-called grandfathered plans — plans that existed on March 23, 2010, and have stayed basically the same — to include some of its key provisions, such as no limits on lifetime coverage. But grandfathered plans aren't required to have all of the consumer rights and protections that new plans must offer, such as free preventive screenings and the right to appeal the denial of a medical claim.
How do I find out if my plan is grandfathered?
Although health plans must disclose whether they're grandfathered, plan materials can be hard to decipher. Your best bet is to consult your insurance company or your health plan benefits administrator at work.
Do I have to stick with a health plan offered by my employer?
You might have choices. You can renew or change your coverage during your employer's annual open enrollment period. Or if your employer does not offer good insurance — "good" meaning that a plan doesn't cost more than 9.5 percent of your income and pays at least 60 percent of your covered medical expenses — you could shop for coverage through the marketplace, and you might qualify for financial help.
What if I miss my employer's open enrollment deadline?
You'll likely have to wait a year to enroll in the employer-sponsored plan or make changes in your coverage. But if you have a qualifying "life event," you may be able to change your coverage sooner.
I have Medicare. Do I do anything differently?
Medicare isn't part of the marketplace, and Medicare plans aren't offered through the marketplace. If you're already receiving Medicare benefits, you're covered.
When will I be notified of changes in Medicare plans for 2014?
Cost and benefit details of the Part D and Medicare Advantage plans available in 2014 will be posted online by Oct. 15. By late September, you should receive an Annual Notice of Change (ANOC) document that details any changes in your plan's premiums, copays, deductibles and coverage. It's important to look at these changes and avoid unwelcome surprises when they become effective Jan. 1.
What if I want to change options for my Medicare coverage?
The annual Medicare open enrollment period (pdf) of Oct. 15 through Dec. 7 is the time to do it. If you don't want to change anything, you don't need do anything — your current coverage will continue next year.
How can I find out more about what the health care law means for me?
Alan Green is a freelance writer.
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