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A Marketplace for All

By John A. Pickens
Executive Director
Alabama Appleseed Center for Law and Justice

Alabama’s Health Insurance Marketplace (“the Marketplace”) will open for enrollment for individuals and small businesses on October 1, 2013.

The Marketplace has been developed under the federal healthcare law passed in 2010 known as The Affordable Care Act (“ACA”). Having been upheld as constitutional by the U.S. Supreme Court in 2012, the ACA is the law of the land and its implementation is beginning.

This is a historic time as it is the first time that no American will be turned down for health insurance coverage because of a pre-existing health condition and it ushers in a time when quality and affordable healthcare and health insurance coverage will be available to all Americans.

This development is not an abstraction for me. Seven years ago my second grandson was born with a major heart defect that required open heart surgery to re-position the major arteries leading into his heart. It was a successful operation and now he is a very normal seven-year old. As a grandparent it is very comforting to me to known that by reason of the ACA no insurance company will ever have the ability to turn him down (or his parents for him) health insurance coverage because of his pre-existing condition and that when the time comes for him to purchase his own health insurance, there will be affordable health insurance plans offered to him in a competitive marketplace.

Likewise, I feel comforted to know that when my little two-year old granddaughter becomes of age and applies for health insurance coverage the ACA will assure her that she will not be charged more for health insurance just because she is a woman.

For these reasons, and for the health and financial security benefits that will flow to all Alabamians, I want to share the following information about the ACA and the Marketplace.

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Under the ACA individuals are required to have health insurance in place by January 1, 2014, or face penalties imposed at tax time in April. Individuals (and families) with incomes less than 400% of the federal poverty level will be eligible for financial assistance ( “subsidies”) to help them with the purchase of a health insurance policy. 400% of the federal poverty level for a family of four is $94,200.

Because of this mandate, the Marketplace is an essential structure designed to assist individuals and small businesses to find and take out quality and affordable health insurance.

Under the ACA small businesses with fewer than 25 employees are eligible for tax credits when they buy coverage for their employees through the small business part of the Marketplace known as the SHOP marketplace. The reporting and enforcement of employer mandates for large employers (50 or more employees) is postponed until 2015.

Insurance plans in the Marketplace will be offered by private insurance companies, and these insurance plans, called Qualified Health Insurance Plans, are required to cover a core set of ten (10) essential health benefits, which include emergency room services, hospitalization, maternity and new born care, prescription drugs, and lab tests.

And for the first time all these plans will be required to provide specialty medical treatments for health problems faced by women. By going on-line to the Marketplace, individuals will be able to see their health insurance coverage options and compare plans so that they can find a health plan that meets their needs and fits their budgets.

Everyone should go to the following website to learn about Alabama’s Marketplace and sign up for email or text updates.

The website is www.healthcare.gov and a 24/7 Marketplace consumer assistance call center is 1/800/318-2596. Those of you who already have or are provided health insurance coverage might also want to find out about the Marketplace in case your health insurance is suddenly terminated for some unexpected reason.

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Owners of small businesses with fewer than 25 employees should also visit this website and learn about available tax credits and health insurance plans. The call center for small businesses is 1/800/706-7893(9:00 AM to 5:00 PM). And the term “small business” includes both for profit and non-profit organizations and most professional entities, like law firms.

When open enrollment begins on the Marketplace on October 1, 2013, individuals should go to the Marketplace website www.healthcare.gov, compare available options, and apply for coverage. Enrollment on-line will take place though a single application, and if application is made by December 15, 2013, coverage will be effective by the deadline date of January 1, 2014. Open enrollment continues through March 31, 2014.

Alabama, let’s do our part and take advantage of this opportunity to improve the health and well-being of our citizens.

John Pickens is the Executive Director of the Alabama Appleseed Center for Law & Justice, Inc., in Montgomery. He can be reached at [email protected]

John A. Pickens
Written By

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