Individual insurers sell Obamacare-compliant policies as well, but you cannot obtain subsidies unless you buy on the exchanges. If you’re not eligible for subsidies, you can sign up directly with an insurer to get covered, and the policy still must provide 10 essential benefits Obamacare requires.
If you live in one of the majority of states using the exchange created by the federal government, visit Healthcare.gov to sign up. Below are links to the open enrollment websites for states that operate their own exchanges.
Obamacare provides “Advanced Premium Tax Credits,” which is a fancy way of saying the government lowers your monthly health insurance premiums by paying part of your costs. These Advanced Premium Tax Credits are your “subsidies.”
Subsidies for Obamacare are calculated based on your income and the costs of a benchmark plan, which is the second cheapest “silver” plan in your area. There are four tiers of Obamacare plans, with bronze plans providing the least coverage and platinum plans providing the most coverage. A silver plan covers around 70% of your healthcare costs .
Obamacare provides subsidies so you pay no more than a set percent of your income for your benchmark plan. This chart shows the maximum percentage of income you’d have to pay :
|
Your income as a percentage of the federal poverty level |
Max percentage of income paid toward buying your benchmark silver plan |
|---|---|
|
Up to 133% |
2% |
|
133%-150% |
3%-4% |
|
150%-200% |
4%-6.3% |
|
200%-250% |
6.3%-8.05% |
|
250%-300% |
8.05-9.5% |
|
300%-400% |
9.5% |
If you want more coverage than a silver plan provides, you must pay the difference. If your benchmark silver plan costs you $100 a month after your subsidy and a gold plan costs $500 more than the silver, you’d have to pay $600 monthly for the gold plan.
It’s imperative you estimate your income correctly. If you underestimate what your family will make during the year you receive Obamacare subsidies, you may have to pay back the Advanced Premium Tax credits you were provided .
What you’ll need to sign up
To sign up for coverage, be ready to provide the following information:
- Basic demographic information: You’ll need names, birthdays, and social security numbers for you and any dependent or family member in your household or on whose behalf you’re applying for coverage. You’ll also need a home address — not a P.O. box — for everyone on your application, as your location affects coverage.
- Immigrant documentation: You’ll need immigration information if you or anyone on your application is a lawfully present immigrant. Examples include an alien number and receipt number from a green card; an alien registration number from a reentry permit; or information from your refugee travel documents.
- Information on your tax filings: You’ll need to be ready to state whether you file separately or jointly if you’re married. You’ll also need to know who is claimed as a dependent on your taxes.
- Information about employers and income: This must be provided for everyone in your household, including people not applying for coverage. Income includes W-2 wages and salaries, tips, self-employment income, unemployment income, Social Security income, alimony, pension and retirement income, rental income, investment income, and any other taxable income.
- Information on current health coverage: You’ll need these details for anyone on your application including any family member with Medicare, Medicaid, CHIP, or TRICARE. You’ll also need to provide information on any family member receiving coverage through an employer or eligible for employer-based coverage.
Shopping for a plan
When you are ready with your documentation, visit your state exchange or Healthcare.gov and sign up for an account. You can compare plans and prices without registering, but must register to see exact premium costs or to get enrolled.
When you have logged in and input your information, you’ll see a list of plans. You can sort based on plan level (bronze, silver, gold or platinum), premium cost, deductible, or plan features. You can also compare plans and estimate total yearly costs on each plan.
When you shop for plans, look at the big picture and not just premium costs. You’ll see a screen like this for different plans available to you:
Key factors to compare include:
- Premiums: The monthly amount you pay for coverage. Higher premiums mean you pay more up front for coverage but will have lower costs as you use services.
- Deductibles: This is the amount you pay before your insurer starts picking up the tab. If you have a $1,000 deductible, you pay $1,000 out of pocket for covered services before your insurer pays for most care. Some types of preventative care, like annual exams, are covered even before you’ve met your deductible.
- Out of pocket maximum: This is the maximum amount you’ll need to pay for covered services during the year. Once you pay your maximum, the insurer pays for all other services the policy covers. There will be an individual and family out-of-pocket maximum if your policy covers more than one person.
- Coinsurance costs: This is the amount you pay for covered care after your deductible is met. If you have 20% co-insurance costs and a $1,000 bill, your insurer pays $800 and you pay $200.
If you expect to use more healthcare services, look for a plan with higher premiums and lower coinsurance costs and out-of-pocket maximums. You’ll also want to get more details about each plan you are considering, which you can do by clicking on the links below the plan for the Summary of Benefits and Provider Directory.
The summary of benefits explains what, exactly, is covered and excluded. Pay particular attention to copays, which are the amounts you must pay to see a doctor or to see a specialist.
You’ll also want to see if you have coverage for out-of-network care. Most insurers have a network of doctors they partner with who accept agreed-upon rates. If you need out-of-network care, you’ll have to pay more. The plan summary details how much more.
Finally, the provider directory lets you know if the doctor you want to see accepts the plan you’re thinking about buying. If it is very important you have coverage from a specific provider, call that provider to confirm they will accept your plan, as insurers do not always keep directories up-to-date.
When will your coverage begin?
If you sign up anytime during open enrollment from November 1 through December 15, your coverage will begin on January 1, 2018.
Make sure to sign up during the open enrollment period if you need coverage for next year, as you will not have another opportunity to get covered in 2018 unless you experience a qualifying life event such as getting married or losing your job.
If you do not have coverage, you could also face a tax penalty for not getting insured. Don’t take a tax hit– or take on the major financial risk of going without insurance.
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