Beginning in October, you’ll have the opportunity to enroll in new plans for individuals and families that will start on January 1, 2014.
Financial help from the federal government
There are two types of financial help from the federal government that may be available to you. One kind helps pay your monthly health insurance premium. The other helps with your out-of-pocket expenses for care. You may qualify for one or both, and the federal government can pay your health plan directly.
- Qualification is based on your income and family size, where you live, and if you are a U.S. citizen or legal resident in the U.S.
- You can apply for federal financial help starting in October 2013.
- You can only get financial help when you buy coverage through your state or federal Health Insurance Marketplace.
Here are some general income guidelines that might be used by the government to see if you qualify for federal financial assistance. The amounts below are based on 2013 numbers, and are likely to be slightly higher for 2014.
- If you’re single, you could qualify if you make less than $45,960 (or if you live in Hawaii, less than $52,920).
- For couples, you could qualify if you make less than $62,040 (or if you live in Hawaii, less than $71,400).
- For a family of four, you could qualify if you make less than $94,200 (or if you live in Hawaii, less than $108,360).
Health Insurance Marketplaces
Marketplaces are state- or federally-run markets where you can shop, compare, and buy individual or family health care coverage. They are sometimes called “Exchanges.”
- You can buy coverage through the Marketplace beginning October 2013. The coverage may start no sooner than January 1, 2014.
- You can choose a plan based on price, benefits, quality, and other features that are important to you.
- Kaiser Permanente plans will be available in the Marketplace.
You don’t have to buy from the Marketplace. You can still buy directly from Kaiser Permanente. (Exception: Residents of Washington, DC, must buy coverage from the Marketplace.)
Kaiser Permanente members, link directly to the Health Insurance Marketplace for your state here.
Levels of coverage
Marketplaces will have several levels of coverage offered by different insurers. You can choose among the plans according to your personal situation and needs.
- All plans will offer the same essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care), and include certain preventive services at no cost.
- All plans will be grouped into several levels of coverage. These levels (referred to as Metal tiers) were set up by the federal government to make it easier for people to compare plans offered by different insurance companies.
- The most affordable level would generally offer lower premiums but higher copayments, coinsurance, and deductibles. The other levels would generally have higher premiums but lower deductibles, coinsurance, and copays.
- If you qualify, you will have the additional option of a Catastrophic Plan, which is usually a high-deductible plan with low monthly premiums.
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