A signature part of President Obama’s health care law goes live this week. Open enrollment begins Tuesday in so-called health insurance marketplaces.
Various estimates have the marketplaces potentially affecting about 350,000 people in New Jersey, upwards of 800,000 people in Pennsylvania and about 35,000 people in Delaware.
Not for everyone
The marketplaces are open to anyone, but they’re mainly geared toward people who are uninsured or who have individual insurance policies, separate from work-based coverage.
“I guess I’m kind of hoping in the back of my mind we’ll be able to get that for a little less money,” says Tammy Bradshaw, a self-employed photographer in Philadelphia. She and her husband pay $800 a month out-of-pocket for a plan that also covers their 2-year-old.
Another key detail for Bradshaw is whether the marketplace plans will cover her current physicians.
The marketplaces are also aimed at people like Nathanial Scott, a 24-year-old that is uninsured.
“My biggest concern is that one day I go through a medical emergency and I require a visit to a hospital or what have you, and I’m kept maybe overnight or for a couple days,” says Scott. “Then after I get out I get a bill from the hospital for like thousands and thousands of dollars, and then my head’s spinning saying, ‘oh my goodness, how am I going to pay for all of this?! On top of everything else I’m paying?'”
Based on a federal report out last week, a plan might cost Scott about $100 a month, if he’s eligible for tax credits being offered to income-eligible individuals to buy coverage.
Small businesses can also shop for coverage, but not until November. Starting next year, people may also face fines for not having coverage.
What will the plans cost and offer?
These state-based marketplaces are often described as ‘Travelocities’ for health insurance: Online sites where consumers can compare and shop for health plans, which must meet certain coverage requirements. Participating insurers, for example, must cover certain mental health and addiction services and will be barred from denying people coverage or charging them more if they have pre-existing health conditions.
The marketplaces are also where people can learn whether they’re eligible for other coverage, like Medicaid. Eligibility for that program, for example, will expand in New Jersey and Delaware starting in January.
Experts say cost of coverage will depend on several factors, including a person’s age, income and where they live. Preliminary numbers, for example, show that the same plan may cost more in Philadelphia than in Pittsburgh. For a sense of the cost of plans and subsidies in each state, NPR and Kaiser Health News have developed a marketplace calculator.