Breakthrough Patient Recruitment

: Enrollment in the Health Insurance Marketplace Begins October 1. Are You Ready?

Enrollment in the Health Insurance Marketplace Begins October 1. Are You Ready?

Managing Editor

In just more than two months, on October 1, open enrollment in the Health Insurance Marketplace, also known as the health insurance exchange, will begin. Insurance coverage through the health exchange will begin as early as January 1, 2014. This is one of the pivotal pieces of the Patient Protection and Affordable Care Act (ACA), and it's a little disconcerting that so few people know even a little bit about what the health exchange is or how it will work.


Currently, 16 states, plus Washington, D.C., have chosen to expand health coverage to those who currently count themselves among the uninsured through a state-based exchange. As for the rest, 27 states elected not to create their own exchange and thus defaulted to a federal exchange, and seven states have opted for a hybrid Partnership Exchange, which enables the state to carry out certain functions of a federally funded exchange.  


But What is it and How Does it Work?


What does the health exchange mean? In Maryland, specifically, 16 percent of the population lives in poverty. Furthermore, 13 percent of our population is currently uninsured, and 10 percent of children-or approximately 138,300 children-currently have no health insurance coverage.


Through the state-based health exchange in Maryland, which is called Maryland Health Connection, 108,000 adults living in Maryland at 138 percent of the federal poverty level will be able to receive health care coverage. In addition, the Maryland Health Benefit Exchange will extend health care coverage to 448,000 state residents who are currently without coverage. Maryland Health Connection will also help an additional 180,000 residents gain quality health care insurance that before was out of their reach.


So how does it work? Insurance plans available for purchase in the exchange are offered by private insurance companies. Plans may be purchased by anyone who does not receive health insurance benefits from their employer (either because the company does not offer them or because they decide not to receive coverage from their employer).These plans are required to all cover the same essential health benefits-the same benefits required of all insurance providers. These essential benefits include emergency services, hospitalization, maternity and newborn care, prescription drugs, preventive and wellness services, and a handful of others.


Meanwhile, part-time employees who are not offered health insurance coverage through their employer may qualify for lower premiums and lower out-of-pocket costs based on the size of their household and their income. Once the exchange opens in October, individuals can complete an application to find out whether they are eligible for any low-cost insurance options. According to, in 2014, an individual making up to about $45,000, or a family of 4 making up to about $94,000, may qualify for these lower costs.


What About the Fine for not Having Coverage?

Starting in 2014, everyone will be required to purchase health insurance or pay a penalty. The fee will start out at 1 percent of a person's income or $95, whichever is higher, for next year. Although not necessarily a cost-prohibitive penalty at first, the fine will increase each year. By 2016, it will be 2.5 percent of a person's income or $695, again, whichever is higher-at which point the fine becomes more substantial for many people. Open enrollment ends on March 2014, so if a person has not purchased health coverage through the exchange by that date, they will have to wait for the next enrollment period.


Understanding health insurance benefits has never been an easy task-even for the most educated among us. And the health exchange is no exception. The Obama administration is attempting to get the word out, and various organizations have strategies in place to help inform people about the looming open enrollment date. As mentioned in part 2 of this series, MMG has partnered with Mobile Commons to offer a text messaging program that assists local, state, and federal organizations provide education about the exchange, including how to enroll.


If you don't currently have health insurance, I ask you to spend some time to familiarize yourself with your options, and once the exchange opens, do some comparison shopping to make sure you and your family are covered. It's a lot of information, and it can be confusing, but the payoff will be worth it.


This is part 5 in the Healthyist's series on the Affordable Care Act (ACA). For more of our take on the ACA, read part 1, Health Reform: You Think You Know but You (Probably) Have No Idea, part 2, Digital Health Features Prominent in Health Reform Changes, part 3, Will a Little-known ACA Provision Give Clinical Trials a Much-needed Boost?, and part 4, Health Literacy: Reading Between the Lines of the Affordable Care Act.

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