How to apply for benefits

(AP) As enrollment under the Affordable Care Act opens, those seeking coverage will need accurate income information, plus some understanding of how health insurance works.

The process involves federal agencies verifying your identity, citizenship and income, and you have to sign that you are providing truthful information, subject to perjury laws.

This April 30, 2013 file photo shows the short form for the new federal Affordable Care Act application in Washington. Getting covered through President Barack Obama’s health care law might feel like a combination of doing your taxes and making a big purchase that requires some research. You’ll need accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that’s right for your needs. (AP Photo/J. David
This April 30, 2013 file photo shows the short form for the new federal Affordable Care Act application in Washington. Getting covered through President Barack Obama’s health care law might feel like a combination of doing your taxes and making a big purchase that requires some research. You’ll need accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that’s right for your needs. (AP Photo/J. David

After state health insurance markets open Oct. 1, consumers can apply online, via a call center, in person or by mail. Trained helpers are supposed to be available.

When you sign up, you will have to identify yourself and your family members, provide current information on income, jobs and any available health insurance options, learn how much financial assistance you’re entitled to, shop for a health plan and enroll.

Many people will qualify for tax credits to help buy a private plan through the state markets. The government will send money directly to your insurer, and you’ll make arrangements to pay any remaining premium.

The poor and near-poor will be steered to Medicaid in states that agree to expand that program.

Here’s an overview of what to expect applying online:

Go to healthcare.gov and click on “Get Insurance.” You’ll set up an account and password. You’ll provide your contact information and the best way to reach you.

Once you take up the actual application, you’ll need birth dates and Social Security numbers for yourself and other family members listed on your federal tax return.

You’ll also be asked about citizenship. Legal immigrants will need their immigration documents.

Next in the application process is income. Be sure to keep handy your most recent tax return, pay stubs and details on other kinds of income, such as alimony, pensions and rents. You can still apply if you haven’t filed a tax return. You’ll also be asked about access to health insurance through your job. You may be required to take that insurance if it’s available.

Your personal and income details will be routed through a new government entity and will pass through agencies like Social Security, Homeland Security and the Internal Revenue Service for verification. The feds will also use a private credit reporting company to verify income and employment.

How smoothly all this will work is one of the big unknowns. It could get tedious if discrepancies take time to resolve.

Most people will receive a tax credit to help cover premiums. Credits are based on income and keyed to the premium for a benchmark plan known as the “second-lowest cost silver plan” in your area.

After you have a tax credit, you can finally shop for insurance. But it’s important to choose wisely — you’ll probably have to live with your decision until the next annual enrollment period.

There are up to four levels of coverage to consider: bronze, silver, gold and platinum. Plans at every “metal level” cover the same benefits and have a cap of $6,350 a year in out-of-pocket expenses for an individual, $12,700 for families.

Bronze plans generally have the lowest premiums, but cover only 60 percent of medical costs on average. Policyholders will pay the difference, up to the annual out-of-pocket cap. Platinum plans have the highest premiums, but cover 90 percent of costs. Young adults up to age 30 can pick a skinny “catastrophic” plan — but tax credits can’t be used on these.

Make sure your doctors and hospitals are in the plan you pick. You may have to check the plan’s own website, or call your doctor.
Your share of the premium could be lower — even zero — if you apply your tax credit to a bronze plan. It’s because the credit is keyed to the cost of a silver plan, which is generally more expensive.
Check if you are eligible for “cost-sharing subsidies,” in addition to your tax credit. Extra help with out-of-pocket costs is available to people with modest incomes, but only with a silver plan.

Posted on Wednesday, October 9, 2013 at 2:46 pm