Oct. 29, 2014
The Texas Medical
Association’s (TMA’s) “Hey, Doc” education campaign wants to make sure Texas
patients have the information they need to purchase health insurance through
the new insurance marketplace.
The re-enrollment period to purchase coverage through the marketplace starts
Each week over the new
few months, TMA will answer the most frequently-asked questions. This week,
TMA’s “Hey, Doc” education campaign explains the marketplace, why Texas
patients who need insurance should care, and how they can get ready to sign up
for marketplace insurance.
You can find each week’s Q&A and more
information at Heydoc.texmed.org as
well as in TMA’s patient blog, MeAndMyDoctor.com.
Exactly Is This Marketplace and Why Should I Care?
The ACA says most individuals must
have health insurance as of 2014. So the law required that health insurance
exchanges — or “marketplaces” — be established in every state as a way for
individuals to buy private health insurance on their own.
Most people get insurance through their jobs.
But if you don’t have that option, you can shop in the marketplace instead of
buying directly from an insurance company. Or maybe you have a certain health
problem that in the past prevented you from getting health insurance because it
was too expensive or simply hard to get. Now you will have options in the
All individual and small-group health plans
must provide a minimum package of “essential health benefits,” which include a
basic set of services like physician visits, hospital and emergency care,
preventive services like vaccines and screenings, and prescription drugs. So
any health plan you purchase inside or even outside the exchange must cover
these services, and the insurance company cannot deny you coverage because of a
Instead of having to search out health plans on
your own, the marketplace is designed to be a one-stop-shop where you can go
online to check out your coverage options, get easy-to-understand information,
and compare plans before you make a decision — kind of like Orbitz or
Travelocity, but for health insurance instead of travel. You also can find out
right then and there if you can get a tax break on your private insurance
premiums or if you qualify for state programs like Medicaid or the Children’s
Health Insurance Program.
The time to sign up for plans offered in the
marketplace is approaching fast: Open enrollment begins Nov. 15 for coverage
beginning Jan. 1, 2015. Unless you qualify for an exemption under the federal
law, you must get insurance or you could have to pay a fine.
Can I Get Ready to Sign Up?
You will have some
decisions to make and important information to gather to sign up for health
insurance coverage when the marketplace opens again on Nov. 15. But there are a
few things you can do now to get ready:
- Learn about different types of
health coverage so you know what kind of plan fits you or your family.
- If you already have a marketplace
plan from 2014, you can keep your current one or shop around to change plans.
- Make a list of questions you may
have before it’s time to choose a plan, such as whether you can keep your
- Make sure you understand how
coverage works, including things like premiums, deductibles,
and copayments. This will help you determine what
you have to pay and when.HealthCare.gov and BeCoveredTexas.org can help you understand these and other insurance terms.
- Gather information about your
household income, for example, pay stubs, W-2 forms, or tax returns. You will
need this information to determine what kind of plan you may want, and whether
you qualify for tax credits or subsidies. When you enroll, you also will have
to provide information on any insurance you currently have, such as policy
numbers and employer coverage.
- Set your budget.
- Ask your employer if it plans to
offer health insurance coverage in 2015. If not, you may have to find insurance
through the marketplace or other sources.
is TMA’s “Hey, Doc” content schedule through Nov. 26, 2014.
Week of Nov. 6: Where can I get more information about the Marketplace?
Week of Nov 19: What if I have insurance
through my work or family? Do I have to buy insurance through the marketplace?
Week of Nov. 26: What happens if my insurance
company canceled my plan? Can I still keep it?
TMA is the largest state medical society in the nation,
representing more than 47,000 physician and medical student members. It is
located in Austin and has 112 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
cell: (512) 650-5336
Click here to follow TMA on Twitter. Or visit TMA on Facebook.
Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.