What to expect when health insurance exchanges open

A doctor calls a patient in the waiting room.

October 1st is when insurance exchanges and new insurance plans open as part of the Affordable Care Act.

Dan Gorenstein covers health care for Marketplace, and says it’s a big day for insurance in the U.S. "What is really going to happen here is … state exchanges, and federally-run exchanges all around the country are going to begin offering people who are currently uninsured … insurance.”

Those new exchanges will be open on websites. “So you can go online to a website, similar to Travelocity, and kind of shop for the health care plan that makes sense for you most,” says Gorenstein. “People have from October 1st through March 31st to sign up for coverage.”

If you’re new to health insurance, you might not know what that entails. Health insurance on the exchanges will typically be comprised of monthly premiums, out-of-pocket, or co-pay, prices and figuring out what network of providers, hospitals, doctors and specialists you’ll be using.


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As for the price? It’s a little complicated, but it mostly depends on how much money your household earns and how old you are. “The sticker price, the price that you actually see on the website, is going to be anywhere from $150 to $650 per month,” Gorenstein says. “That’s before these federal subsidies kick in. Lots of people will be eligible, for some federal subsidy.”

Though the sticker prices you initially see will vary, Gorenstein highlights an example of a 28 year old and a 62 year old that both make $28,000 a year. Though their initial price will be different, once subsidies kick in, they’ll pay the same cost. “It’s really a calculation based on how much you earn,” Gorenstein says.

Still,  people will still have the option to decline to purchase health insurance. What happens in that case, Gorenstein says, “is you’ll be fined 95$ or 1 percent of your income, whichever is higher. And that penalty ratchets up. It gets higher again in 2015, and higher again in 2016, and that’s when we’re not talking about 1 percent of your income, we’re talking about a penalty with some real teeth to it.”

Some of this might still be confusing, but there are resources for people to use to figure this all out. “The federal government has set up a website, HealthCare.gov,” Gorenstein says, to help people choose a health insurance plan. “There are people called navigators, or ambassadors, and I would strongly encourage anybody who’s really thinking about ‘what plan is best for me’ to have a conversation [with a navigator]. This is very dense stuff. You need to appreciate how much money you make a year, you need to understand how sick you and your family are, and depending on those factors it’s going to vary from person-to-person what kind of plan is best for you.”

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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