(This article was last updated on October 12, 2014)
Looking for help with Healthcare.gov? The ACA has a website that covers pretty much any question a person would have about getting health insurance. That said, it still doesn’t mean that the website is easy to work with. We take a closer look at Healthcare.gov and we try to address the concerns of many whom have contacted us with requests for Obamacare Website Help.
Getting Started On Healthcare.gov
Under the tab “Learn” folks will find tabs for “Individuals and Families”, “Small Businesses” and “All Topics”. This is the tab that seekers will want to explore first when beginning to research the Affordable Care Act and its requirements. The “Learn” tab contains information on almost every single question a person could have. If a person is searching for information regarding tips and tricks to sign up, saving money or choosing a plan, it’s in there. If someone does not know much about the healthcare system and the insurance they are now required to have under the law, there is a section that explains what it is and what it does. There is a section for the laws and people’s rights regarding the whole thing (The Affordable Care Act), and there is a section for what to do if folks have coverage through their employer or coverage outside of the Marketplace. The “Learn” tab on Healthcare.gov is self-explanatory and it will get mostly everyone through the process.
This article is for those who have never had insurance before, who do not know how to get it, and who view the whole thing as an foreign language. Understanding the website and how to sign up for insurance on the federal Marketplace can be confusing to someone who is previously had cover through their parents and who never had to think about it before. People who lost insurance coverage previously from their employers or those who have had their coverage dropped all together may not understand how to go about getting insurance either. There are even provisions that explain the implications of Obamacare and the requirements imposed on people who are self-employed and have no employees. Read over the “All Topics” sub-tab under the “Learn” tab thoroughly to understand the system and how it works, for whom it works and the tips and ideas for applying.
If you have a question on a particular topic or just have a general question, one of the best parts of the website under the “Learn” screen is the search bar on the right side of the page. If you do have particular questions or simply want to learn about a general topic, you can obtain the same information within this website.
In addition to the “Learn” tab, a person can also find video tutorials that give people an overview of the site, help people sign up, discover eligibility and find a plan. Also on the same page are frequently asked questions and news and events, describing changes or updates.
One of the main issues that people face, who are new to health insurance or timid about the process, is where to find help enrolling for insurance on the federal Marketplace website. This article will provide you the help you are seeking navigating the website. So, get comfortable; this is going to take a while.
How to Apply at Healthcare.gov
If you are ready to enroll for healthcare on the federal Marketplace, it is best to have handy the birth certificates and social security numbers of those who will be on the policy with you. This means spouses and dependent children. It would also be a good idea to have last year’s tax records, W2’s and recent paycheck stubs available for the information they contain.
To start an application for insurance you should first click on the tab beside the “Learn” tab, which states “Get Insurance”. This is also found at the top of the website. If you have already created an account through Healthcare.gov, you can log in and continue your application or review insurance policies on the “Log in” tab also at the top banner of the website.
If you are trying to enroll outside of the enrollment period, which starts on November 15 and ends on February 15 for the 2015 calendar year, you will immediately receive a notice that says that open enrollment is over. Don’t panic. There are ways to get around your tardiness, such as a qualifying life event like pregnancy, change of jobs, marriage and such. Folks who may qualify for Medicaid or CHIP, the children’s insurance program, can sign up at any time because there is no enrollment period for those programs. People who experienced some sort of hardship that prevented them from enrolling during open enrollment may also be able to enroll after the deadline passes without consequence. If one of these applies to you, then proceed through the enrollment process. If none of these apply to you, then you should sign up for a private health insurance plan that complies with the law and wait until the next open enrollment period to pick up a policy on the federal Marketplace. If you think you could have qualified for a federal subsidy, paying for a private health insurance plan may be more costly, but it will help you avoid the full penalty tax for not complying with the law. If the full penalty tax is less expensive than paying for a private plan, you may choose to simply wait for the next enrollment season.
Once in the “Get Insurance” tab, tap on the “Select Your State” box, which will pull down a drop down menu of every state. If you indicate that you live in a state that manages and administers the requirements of Obamacare on its own, you will be forwarded to your state’s exchange to enroll for healthcare. For the purpose of this article, we will walk you through an application on Healthcare.gov as if we lived in the State of Georgia, which uses the federal Marketplace on Healthcare.gov. After selecting the State of Georgia, you will click on “Apply” to begin the enrollment process on the website.
Get Started With Enrollment
Step 1: You will go through a series of pages detailing information concerning yourself and your family, if you have family you want on the policy. This will entail personal information and financial information. To begin with, you will put in your name and choose a password. This is to create an account. On the next page you will agree to the terms and conditions.
- Next you will type in name, address, SSN, email address and phone number. You will be directed to go to your email account to authorize the application. After this page will come one on which you will answer questions to verify your identity. Following this will come a page that says congratulations, you’ve been verified and may continue to the marketplace. The next page will say start your application. You will press next.
- The next page will give them phone and email and snail mail information along with preferences as to text messages or emails. Save it and continue.
- If all of that went through and you didn’t have to re-enter anything, you will be asked if you are receiving help from anyone like professional counselors or navigators. Answer it and go on. On the next page, they will make sure that if no one is helping you fill out the application, then anyone who has your permission in future to help you will be allowed to do so. Fill in the security questions and proceed.
- Now you will answer questions concerning your income for the purpose of discovering if you need help paying for your insurance. You will be asked if the coverage is for you, you and your family members or family members and not you. If you make between 100 percent to 400 percent of the federal poverty line, you may qualify for federal assistance. This means that if you make between $11,670 and $46,680 for an individual and between $23,850 and $95,400 for a family of four, you could qualify for a subsidy from the government. Consult the tab that says Individual Mandate for more information.
- At this point, the website will warn you that you must complete this section at one time. If you log out, you could lose all the information and have to begin all over again. With that said, the page will ask for questions regarding each and every member of the family. The sex, social security number and citizenship status will be required. There will also be questions regarding your last tax return. Race and ethnicity questions will also be asked.
- This section is included in the complete at the same time category. It will ask if any family member has a disability or needs help with daily living and functioning. These are optional questions. The next is not. It will ask if any family member was ineligible for CHIP (children’s health program) or Medicaid previously. The next questions will ask if anyone is an Alaskan Native or a Native American or if anyone is pregnant.
- Review the information in the family and household portion of the application.
Important Note About Healthcare.gov
If, at any time, the website locks you out and says it is having a problem, it will direct you to logout and log back in. It will give you an application ID number. When you log back in, you will be directed to continue your application. Be aware that this could happen several times in the course of the application. Yes, it’s aggravating, but have patience. You’ll get through it in time. The pages you previously filled in will reappear for your approval. You might need to fill in some things again. Do so, save them and continue.
Step 2: This will be the financial portion of the application. This is where the tax returns, W2’s and paycheck stubs will come in handy.
- You will be asked if you have a job or are self-employed, for whom you work and your gross, net or annual income therefrom. You will also be asked if you have income from and to tick off one of:
- Social security benefits
- Capital gains
- Rental properties
- Royalty payments
- Fishing or farming income
- You will be asked if you pay alimony or student loan interest that could be applied to your tax return. Since that can be checked, you should be as truthful and accurate as possible.
- The application will calculate the amount of money you make each month after deductions. You will be asked to verify the information.
- Next you will be asked if you have health insurance from another source.
- Now you will be asked if you recently lost insurance for any reason or if you are about to lose your insurance in the next 60 days. The application will ask if:
- You recently got married
- You were adopted
- You legitimately immigrated
- You moved to another state
- You were released from incarceration
If you answered yes to any of these, the dates will be required. These questions will only be asked to ascertain if you are eligible for a special enrollment, because open enrollment has ended. You will not pay the fine for this.
- Now there will be a summary of what you have submitted. You will be asked to review it all for accuracy and confirm it. Then you will be asked if you agree that no one applying for health care insurance is incarcerated. That is one exemption for getting health insurance.
- You will agree or disagree that the marketplace may use your tax returns for the next five years for data pertaining to eligibility.
- You will agree or disagree to update your information with the insurance company reflecting changes in income, gaining health insurance through an employer and so forth.
- You will discover on this page whether or not you qualified for a government subsidy to help you pay your premiums. If you passed on financial help, you may proceed to the next page.
Step 3: The personal and financial information is collected. Now you will choose your health care plan. The plans fall under five categories: catastrophic, silver, gold, bronze and platinum. Remember that each state is different regarding certain things, but listed below are the basics of the plans.
A handy thing to know about these plans is that they are based on the actuarial value of the plans. That means the more expensive the plan, the more the insurance company will pay for your health care. Your portion of the costs will be a little cheaper, but the premium paid will be a tad higher. Premiums are based on things like if you smoke, how many family members will be on the plan, your age, your location and your insurance carrier. Keeping these things in mind as well as your financial situation will make searching for the perfect insurance fit a little easier.
Another handy thing to know going in is what is covered. No matter what plan you choose – silver, gold, bronze or platinum – they all offer the same (minimum requirements) health care benefits:
- Ambulatory Services (non-hospital-related medical services)
- Newborn and children’s care
- Chronic disease care such as diabetes and asthma
- Emergency care
- Maternity care
- Mental health care
- Occupational and physical therapy
- Wellness and preventive care
- Speech therapy
This is for the individual or family who might only need coverage when something bad happens. Copays and coinsurance payments for medical services and deductibles will be higher, but monthly premiums will be lower. Preventive care, check-ups and prescription drugs may not be covered. Catastrophic plans are generally PPOs. Supplemental plans are for supplementing other insurance plans. Things like medical appliances, home nursing care and psychiatric care would be covered under a supplemental plan. Comprehensive plans still carry the higher doctor visits and deductible, but emergency care and ambulance transportation is covered.
Benefits of catastrophic plans include:
- You are under age 30 or experienced a hardship
- You are basically healthy
- You have no pre-existing medical conditions
- You’re not on regular prescription drugs
- You rarely see the doctor
- You can’t afford more robust coverage
- You expect to have other coverage within 6-12 months
- You only want coverage in case of emergency
The Bronze plan was intended to be the minimum health insurance coverage people could get. It has the lowest premiums per month, but has the highest out of pocket charges of the five plans. This plan pays a 60-40 split, with you paying the 40 percent. The deductible is $5,000. Very few offer no deductible at all, but they are out there.
Tip: Shop each level for prices. Some silver premiums might be cheaper but with a higher deductible, whichever you feel more comfortable with.
Silver plans generally have a higher monthly premium, but they have lower out of pocket costs. Silver plans usually pay 70 percent, while you pay 30 percent of the costs. Silver Plan A consists of a high deductible at $2,000 but a low 15 percent coinsurance. Silver Plan B includes a low $250 deductible but a high 30 percent coinsurance. Only three percent of silver plans offer no deductible at all. Also, only silver plans offer cost discounts for things like the deductible, monthly payments and copayments. If your income is below 250 percent of the federal poverty line, you will be eligible for discounts.
Tip: The discounts don’t come figured in to the price of the insurance; you have to apply for discounts.
If, on the other hand, you don’t mind paying a higher premium so that the insurance company picks up more of the costs, then the gold plan is for you. Gold plans typically pay 80 percent, with the other 20 percent paid by the insured. In that 20 percent is the deductible, coinsurance and copays. Only six percent of gold plans offer no deductible at all. Gold plans A and B offer the same deductibles and coinsurance as the silver plan. This plan is for those who don’t mind paying a little more to be spared huge insurance payments. This plan is also for those who use their insurance regularly.
Tip: Ask about HSAs. They can be combined with a higher deductible plan, or you could get an HSA with your plan and use both together.
The platinum plan is the highest of the insurance levels. Around 41 percent of insurance companies on the exchange offer no deductible. The platinum plan offers a 90-10 split, with you paying the ten percent in copays and coinsurance and deductible, if any. Some plans only offer a $400 deductible, while others might offer a $1,000 deductible. With these plans, your coinsurance could be as low as five percent. This plan is perfect for those who have chronic diseases, who visit their doctor regularly and who need medications each month. Keep in mind that a lack of deductible doesn’t mean you’ll have zero charges to pay; they will simply be capped at a yearly maximum.
Other Things to Think About
Remember that all metal plans cover the same benefits. The only difference is how dispersal of money goes. By that, we mean the percentage the insurance company will pay. Unfortunately, you can’t upgrade to the gold or platinum level of whatever plan you choose. You must work within the plan that is right for you.
Basically, if you’re young and relatively healthy, you won’t need the most expensive plans out there. On the other hand, unexpected stuff happens and will need to be paid. There’s a plan for that. Others rarely use their insurance, but it’s there when they need it. There’s a plan for that, too. More folks need just bare-bones coverage to get by, because that’s the law or they’ll pay a penalty for not having it. In most all cases, if you know you won’t get anywhere near your spending limit, then we got you covered.
The toughest time will come for those who have pre-existing conditions or chronic illnesses. Now that you can’t be turned away, you will find your out-of-pocket expenses pushing you toward your spending limit. As you get near and pass your capped spending limit, there are opportunities to save money. For one thing, your coinsurance and copays will drop. You may even save money each month on premiums. When you reach your out of pocket expenses limit, you are 100 percent covered. All you will pay after that is your monthly premium.
The balance comes when you’re choosing a plan with low premiums. They will have higher out-of-pocket expenses but will be capped at a reasonable rate. However, plans with higher premiums tend to have lower out of pocket expenses with higher caps. Whichever plan you choose, you will quickly reach your out of pocket expenses limit, and the rest of the year will mean greater savings. Just make sure you’re not paying ridiculous premiums once the insurance picks up the rest.
Perhaps the most important thing those with chronic illnesses need to remember is to check the plan for prescription drug or treatment allowances. If you get a plan with lower out of pocket expenses limits, and you still have to pay 20 percent of your expensive prescription drug or treatment, it could be a bit of a surprise. Also, make very, very sure that the plan even covers your prescription drug or treatment. The alternative would be to change drugs or treatment, or to pay for it all out of pocket. Saving money for everyone was one of the original tenets of the ACA. However, if you’re not careful and/or you don’t read the plan very carefully, you could end up paying more than you can afford when what you need was covered somewhere else.