BEYOND THE NUMBERS
With open enrollment in full swing for 2019 coverage through the Affordable Care Act (ACA) marketplaces, Thanksgiving is the perfect time to remind eligible friends and family to enroll. Here are five things to tell your loved ones about marketplace health plans.
- Marketplace plans provide comprehensive benefits, including no-cost preventive care. All plans must cover essential health benefits — ten categories that include doctor visits, maternity services, prescription drugs, mental health and substance abuse treatment, and hospital care. This requirement guarantees marketplace consumers a base level of comprehensive coverage. In addition, marketplace plans provide preventive benefits, such as annual checkups, cancer screenings, and contraceptive coverage, at no cost.
- Many people can get help paying premiums. The large majority of current and potential marketplace enrollees are eligible for federal premium tax credits, which make premiums more affordable and protect enrollees from rising premiums because they rise when premiums rise. In fact, 79 percent of people shopping for coverage on HealthCare.gov can find a 2019 plan with a premium under $75 per month after accounting for tax credits, according to the Department of Health and Human Services. Some uninsured people who are eligible for a credit may not even know it: an estimated 7.5 million of the 30 million uninsured are eligible for a credit, the Urban Institute found. (Another 7.5 million are eligible for Medicaid but aren’t enrolled.)
- Many people can also receive subsidies that lower their out-of-pocket costs. Under the ACA, moderate-income people are eligible for plans with lower deductibles and copays. Over half of marketplace enrollees benefited from these cost-sharing reductions in 2018.
- Marketplace plans can’t place dollar limits on your coverage. The ACA prohibits insurers from setting annual or lifetime limits on coverage. It also limits the total amount an enrollee could have to pay in a year in deductibles and other out-of-pocket costs, providing crucial financial protection against catastrophic medical costs due to illness or injury.
- Marketplace plans can’t discriminate based on pre-existing conditions. The ACA prohibits marketplace plans from denying coverage or charging higher premiums to people with pre-existing conditions. People shopping for coverage in the marketplace won’t face questions about their health history, and they’re guaranteed a health plan that covers all essential health care services, including those related to a pre-existing condition.