Marketplace Open Enrollment 2021 

Submitted by Patient Advocate, Amy DeLay:

It is no secret that healthcare is a hotly debated political topic. As with any controversial topic, there are misperceptions regarding the Affordable Care Act. Before actually working with the marketplace enrollment as a Certified Application Counselor, I too was unsure exactly how the Affordable Care Act worked. After closely working with the marketplace open enrollment for several years, I wanted to share my experiences in case you or someone you know may know someone who would benefit from applying.

One of the important aspects of the Affordable Care Act is that it established minimum standards for coverage. All plans offered on the marketplace offer comprehensive coverage, including preventative care like mammograms, colonoscopies, and flu shots. Secondly, plans on the marketplace cannot deny people or increase prices for pre-existing conditions. This is a very important aspect for our patients here at the clinic as many have chronic conditions like asthma, high blood pressure, or diabetes.

I won’t pretend that the marketplace is a good fit for everyone. However, for some of our patients, it has been a literal life-saver. One patient that signed up for the plan developed cancer later that year. She had previously been without insurance coverage, but thankfully when the cancer results came back, she had coverage through the marketplace. Her insurance plan covered the cost of surgery and chemotherapy, and today she is healthy and cancer free.

The marketplace works by offering tax subsidies to those who are not offered employer insurance but who are under 400% of the federal poverty level (FPL). The lower a person’s income, the higher the tax subsidies are that help pay for insurance premiums. The deductibles and out of pocket maximums also are pro-rated based on income, so individuals with lower income may have deductibles as low as $100 or $300 dollars. Now for those closer to the 400% FPL, they may say that the premium costs and deductibles are out of reach financially. However, for many patients that I sign up each year, their tax credits actually cover the entire cost of the monthly premium, so they are only responsible for the copays and deductibles when they utilize medical care.

One population we see here at the clinic that can benefit from the marketplace are those who are self-employed. Buying a full-cost private plan can be very expensive. Many times the patients we see have no other employees in their business, so they are only looking for coverage for themselves. The marketplace can be a cost-effective option for them.

Temporary employees can also greatly benefit from looking into the marketplace. Many are working full-time but not offered benefits since they are not a permanent employee. Their income puts them over limits for Medicaid, but they are eligible for helping paying for premiums through tax credits on the marketplace. For those trying to establish a work history for the first time, immigrants who are adjusting to life in the United States, or even those just released from incarceration, working a temporary job can be a great starting place to finding long-term employment

An estimator tool is available online with plan costs. The estimator tool is usually very accurate, but to get exact numbers a person must complete the full application. However, just because a person applies does not obligate them to enroll in a plan. Another important clarification is that the website healthcare.gov is completely secure and confidential. I have worked with patients who have googled “cheap health insurance” and gotten bombarded with calls from random agents because their information has been sold. This will not happen on the marketplace website, healthcare.gov. For those less comfortable with the computer, there is a toll-free number 1-800-318-2596 that can be used for phone enrollment.

Open enrollment is coming soon! November 1 through December 15^th is the annual sign up period. If you, or someone you know, have questions about the marketplace, I am happy to do my best to answer them. I always ask patients, “Isn’t the possibility of health insurance for all of next year worth one hour of your time to apply and at least see your options?” Healthcare costs are very expensive here in the United States. We want as many people as possible to get coverage that is affordable, and the marketplace can be just that option for some in our community.