Understanding health care: New options begin Oct. 1

Published: Sunday, Sept. 22 2013 3:25 p.m. MDT

Rachel Jackson drops her son Charlie off at preschool at the University of Utah, Friday, Sept. 20, 2013, in Salt Lake City. Jackson is a 24-year-old mother of one who is beginning to navigate the new rules of the Affordable Care Act, as she will have to get her own health insurance coverage when she ages out of her mother's plan at 26. Oct. 1 marks the first day of open enrollment, when people can begin perusing the federal health insurance marketplace and state-run small-business insurance marketplace.

Tom Smart, Deseret News

SALT LAKE CITY — Having allergies and asthma necessitates many trips to the doctor for 24-year-old Rachel Jackson.

Thankfully, for her own peace of mind, the University of Utah student is covered on her mother’s health insurance plan. But that will change after age 26, when the law no longer allows for it.

Jackson also has to negotiate coverage for her 3-year-old son, Charlie.

"Health insurance will always be in the top-five expenses that I will expect to pay," she said. "It’s like car insurance but more important, because it’s my own body that I have to take care of."

Because she’s always had access to it, Jackson said she has taken health care for granted. She doesn’t look forward to what's ahead, navigating and paying for health insurance by herself, but she can’t imagine life without it.

With many Americans who have either not had health insurance or are for the first time having access to it this year, Jackson is beginning to investigate her options. The 906-page Patient Protection and Affordable Care Act, passed into law in 2010, presents many changes, including increased access and affordability, but also challenges that may require assistance from local and federal advocates to sort through.

Look to Oct. 1

Starting Oct. 1, the federal health insurance marketplace will be open for enrollment, however, many believe it will be a couple weeks before information is streamlined.

Individuals seeking plans are asked to gather various information in order to apply for coverage online, including Social Security Numbers, employer and income information contained on a W-2 tax form and policy numbers for any current plan. The enrollment deadline — for coverage to begin Jan. 1 — is Dec. 15, but the marketplace will accept new enrollees until March 31.

The new law aims to help the approximately 20 percent of Americans who have had trouble getting insurance, whether it has been out of reach financially or otherwise unavailable due to health status, including preexisting conditions. The intent of the marketplace is to provide a way for consumers to compare health insurance plans and to facilitate the expansion of coverage to more people.

Essentially, every American can compare and enroll in new plans each year if desired. But not everyone will have to.

Many individuals will still be eligible or enrolled in plans offered by their employers. Large employers will likely offer similar plans this year to those they've offered before, as the federal government recently delayed penalties that would have applied.

A separate, state-run marketplace — Avenue H — is already available to small businesses and their employees. Enrollment with those plans also opens Oct. 1.

Medicare and prescriptions

Older Americans covered on Medicare also need not worry about upcoming changes, as Medicare enrollment isn't affected by further implementation of the ACA. The major thing the new law does impact for seniors is prescription drug costs, eliminating what has been called the "doughnut hole," or the gap in drug coverage that requires patients to pay the full cost for their medications.

Americans who do not obtain what is defined as "minimum essential coverage" by Jan. 1 will face a fee that increases every year. Fees are assessed per person by the Internal Revenue Service and will be paid on the following year's tax form.

People with very low incomes and others may be eligible for waivers. And individuals between jobs are allowed three months without insurance before the fee is applied.

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