Health care reform 101

Health care reform 101

On October 1, our state's marketplace to buy health insurance will open. The Washington Health Plan Finder is the place to shop for insurance through health care reform.

About a million people in our state don't have insurance.  And while Affordable Care Act is supposed to make going to the doctor easier, the most daunting part might be signing up. So here are some basic instructions that will make the process easier.

Go in prepared with the names and ages of everyone who will be on your plan.  Make sure you have Social Security numbers and your annual income. Then, consider what you want to get out of your insurance.

Michael Marchand is Communications Director for the Washington Health Benefit Exchange. "What do I want in that plan?  What kind of medication do I take?  What chronic disease might I be managing?  There might be plans specific to people managing type 1 or 2 diabetes," Marchand said.

There are currently eight insurance carriers offering 38 health plans and five pediatric dental plans. If you're prepared, it will likely take an hour to sift through all of them, while making sure your preferred doctor or emergency room is covered.

The plans fit within three levels: gold, silver and bronze.

You'll pay a higher premium - or monthly bill - to buy a gold plan, where 80% of health care costs are covered, leaving just 20% out of pocket. As you move down through gold, silver and bronze plans, the monthly premium should go down, but so does the extent of your coverage. Silver plans offer 70% of health care costs covered for the average person, leaving 30% out of pocket. Bronze plans pay 60%. You'll need to decide if you want to pay more up-front or more when you go to the doctor.

"While a premium might be five dollars lower, if you're using the plan and the services more, going up to a higher plan that covers more out of pocket expense may in the long run may be more financially feasible for you," Marchand said.

Then there are the subsidies.  ACA expands Medicaid to adults earning up to 138% of the federal poverty level.  According to the Washington Health Care Authority, that's an annual income of $15,856.  A family of four earning less than $32,500 will also be eligible for Medicaid. A family of four earning less than $90,000 a year is eligible for tax credits to help cover the cost of premiums and out of pocket expenses. Those who qualify for expanded Medicaid or a subsidy must sign up through the state exchange.  People buying their own insurance who don't earn free or discounted coverage can also go directly through an insurance company or a licensed broker.

The website goes live on Tuesday, October first.  The state also has a call center to help walk you through the process.  It answered more than 5,000 calls in the first three weeks of operation.  The number is 1-800-WAFINDER.

People who don't purchase insurance could be fined.  The penalty will be $95 in 2014 but goes up steeply the following years.