The Health Insurance Marketplace, established by the Affordable Care Act, allows consumers to compare health insurance plans based on key factors including providers, services and price. All plans that are part of the Marketplace must contain the same set of essential health benefits, including emergency services, hospitalization, prescription drugs and preventative and wellness services among others.
“Make sure to give yourself plenty of time to look through all of the options to be sure that you are getting the health plan you need,” said Commissioner Donelon. “Pay attention to the doctors and facilities that are part of each network. A licensed health insurance agent can help you explore your choices and also help you determine if you’re eligible to receive financial assistance paying your premium.”
Rate filings for plans on the Health Insurance Marketplace show an approximate average increase statewide of 27 percent in the individual market and six to nine percent in the small group market which are typical of the rate filings happening across the country. To view rate increases by company please visit www.ldi.la.gov/healthrates. Final rates will be posted November 1. In Louisiana, 89 percent of those who enrolled through the Marketplace in 2016 received subsidies; according to the U.S. Department of Health and Human Services the average subsidy covered 80 percent of the cost of premium. Individuals and families who are eligible for Medicaid are not eligible for subsidies.
The Louisiana Department of Insurance (LDI) offers the following tips for selecting the best plan during Open Enrollment:
You may be eligible for a subsidy to help pay your premium. Tax credits are available to consumers who meet certain income thresholds to assist in paying monthly premiums. The subsidy is available for families with incomes between 100 percent and 400 percent of the poverty level who buy coverage through the Health Insurance Marketplace. To find out if you may be eligible for a subsidy or tax credit, visit www.healthcare.gov or contact an agent.
Check your plan’s network. Spend some time investigating which health care providers are included in your plan and considering what best meets your needs for the coming year. A plan with a narrow network will have fewer options for physicians, facilities and emergency services. To learn more, visit www.ldi.la.gov/checknetwork to watch our Understanding Healthcare Networks video.
Decide if a health spending account is right for you. There are tax advantages to contributing to a health spending account (HSA). An HSA allows you to use pretax money to cover eligible health expenses, such as premiums and deductibles, over-the-counter medications and other health related spending. Unlike a flexible spending account (FSA), HSA funds can be rolled over from year to year. If you are purchasing a plan on the Marketplace, make sure it’s HSA-eligible. Usually, HSA-eligible plans have high-deductibles.
There are financial penalties for not having health insurance. In 2017 the penalty for not having health insurance will be 2.5 percent of your yearly household income or a fee for each person in your household who isn’t covered by health insurance, whichever is higher. All penalties are payable on the federal income tax return you file for the year you don’t have coverage.
“As the offerings, companies and premiums can change year to year, it’s a good idea to consult an expert if you have questions about selecting a plan.” added Donelon. The Louisiana Department of Insurance (LDI) maintains a searchable database of licensed insurance agents.
Open enrollment runs through the end of January, but in order to have coverage in place on January 1, you must enroll in a plan by December 15. Additional resources are available on the Louisiana Department of Insurance website at www.ldi.state.la.us.