LINCOLN, Neb. (AP) — Federal officials will open a new marketplace Tuesday to help an estimated 54,000 Nebraskans get health care coverage that will soon be required under the Affordable Care Act.
Consumers can start to enroll online, or get help from local Community Action offices, private insurance agents, some community hospitals, or the Ponca Tribe of Nebraska. The federal government has set up a website, healthcare.gov, with links to state-specific information. Consumers can also call a toll-free help line at 1-800-318-2596.
Here are five common questions about the marketplaces:
WHO CAN BUY THROUGH THE MARKETPLACE?
U.S. citizens and legal residents can choose to buy insurance through the marketplace, even if they're currently insured through an employer. But to qualify for federal tax credits to help pay the cost of their premiums, they have to meet specific income requirements.
The subsidies are available to consumers who make between 100 percent and 400 percent of the federal poverty level — $19,530 to $78,120 annually for a family of three. In addition, consumers have to be paying more than 9.5 percent of their household income for coverage offered by their employer to qualify.
An online calculator is available at: http://kff.org/interactive/subsidy-calculator/
WHAT IS NEBRASKA DOING TO PREPARE?
Nebraska has deferred to the federal government to set up and operate the marketplace. The federal government has awarded grants to two in-state groups — Community Action of Nebraska and the Ponca Tribe of Nebraska — to hire and train insurance navigators who will help enroll consumers.
The Nebraska Department of Insurance held a series of informational sessions about the enrollment process in six different cities in September, but its overall role is limited. The department has been assigned to register the insurance "navigators" who will guide consumers through the process, and will keep a database to verify that each one has received proper training and to help address any complaints against them.
Department of Insurance director Bruce Ramge said state officials have posted information about the marketplaces on the agency's website at http://www.doi.nebraska.gov/aca/index.html
WHAT HAPPENS IF I'M NOT INSURED?
Consumers can enroll as early as Oct. 1, but coverage won't begin until Jan. 1 at the earliest. The enrollment period for coverage next year closes on March 31, 2014. After that cutoff, consumers can enroll only with a major life event, such as a job loss, birth, marriage or divorce.
Consumers who file a 2014 tax return in 2015 will be asked whether they had insurance. Those who don't will pay a fee of either $95 or 1 percent of their income, whichever is greater. Anyone who wants to avoid the fee should enroll by Dec. 31 so they can guarantee coverage by Jan. 1, said Roger Furrer, executive director of Community Action of Nebraska, a nonprofit that is helping enroll low-income residents.
WHICH PLAN IS BEST FOR ME?
The plans offer the same essential benefits, but the premiums and out-of-pocket costs vary. The bronze plan has the lowest premiums, but only covers 60 percent of a typical consumer's out-of-pocket costs. The silver plan covers 70 percent of the cost, the gold covers 80 percent, and the platinum covers 90 percent but has the highest premiums.
Consumers can buy insurance either through an insurance agent, or through a navigator. Insurance agents are allowed to make recommendations for coverage and can sell insurance products directly. Navigators can help walk consumers through the process, but are prohibited from selling insurance or pushing users toward a specific plan.
WHAT WILL THE PLANS OFFER?
The plans will be more expensive but also more comprehensive, with a coverage requirement for 10 essential benefits: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; management of chronic diseases, and preventive and wellness services; and pediatric services, including dental and vision care.
Starting next year, the rules will apply to all plans offered to individuals or through the small-group market to employers with fewer than 50 workers. The essential-benefits requirement does not apply to plans offered by larger employers, which typically offer most of them already.