Department of Human Services

Making Medicare and The Health Insurance Marketplace Make Sense February 2014

Answers to Some of the Most Commonly Asked Questions

February 1, 2014 | 3 min reading time



Q:  Although I know that if I have Medicare I don't need to shop in the Health Insurance Marketplace, but is there still time for others to shop for health insurance in the Marketplace and still get coverage in 2014?

A:  Thanks to the Affordable Care Act, about 85% of Americans who already have health insurance are seeing their benefits and coverage better protected and seeing enhanced benefits.For example, insurance companies can no longer impose life time limits on your health insurance benefits so your insurance company can't stop paying their share once you hit a certain dollar amount.At least 80% of your premium dollar now has to be directed to pay for your health care benefits, and not overhead, such as salaries and bonuses for insurance company executives. If less than 80% is used for health care benefits, your insurance company will owe you a rebate at the end of the year. Also young adults up to the age of 26 can stay on their parent's insurance. These are just a few examples of the benefits of the Affordable Care Act law, since it was implemented in 2010.

For uninsured Americans, roughly 15% of the nation's population, they will finally gain access to quality, affordable healthcare from private health insurance companies.Initial enrollment began October 1, through a new way to shop for health insurance.The Health Insurance Marketplace gives Americans who are uninsured, or who buy their own coverage, a whole new way to shop for coverage.

All private health insurance plans that operate in the Marketplace are required to cover a comprehensive set of benefits, including physician visits, preventive care, hospital stays, and prescriptions.Discrimination based on gender and pre-existing conditions is banned.And many individuals and families will qualify for a break on their monthly premium and other out of pocket costs, depending on their income, through advanced tax credits or through cost-sharing reductions.Be sure to include your income on your application to find out if you qualify for this help.

Nearly half of all Marketplace-eligible uninsured young adults are finding health care coverage in the Marketplace that is $50 or less per month.The health care law is delivering the quality, affordable coverage people are looking for.

It is important for consumers to know that starting in 2014 the law says that individuals of all ages, including children, must have minimum essential health coverage, qualify for an exemption, or make a shared responsibility payment when filing their federal income tax return, as those without health insurance cause insurance premiums to rise for all others.

Again, if you have Medicare, it is high-quality coverage so you don't need to shop in the Health Insurance Marketplace, and you will not have to pay a shared responsibility payment.

Consumers need to know that an accident causing a broken limb can cost upwards of $7500 and a 3-day hospital stay can cost thousands and thousands of dollars, out of pocket, without health insurance. In some cases, emergency health care costs could unnecessarily bankrupt individuals and families. Health insurance coverage through the Marketplace can be peace of mind.

To Enroll:

·apply online at, or

·call 1-800-318-2596 (TTY: 1 855-889-4325) 24 hours a day, 7 days a week, or

·You can also find in–person help from certified assisters in your area. Go to and enter your zip code or city and state. You can also ask the customer service representatives at 1-800-318-2596 for local help in your area.

Initial enrollment runs through March 31, 2014. Be sure to make your first month's premium payment after you have enrolled in a health plan, and check directly with your plan to ensure that your application for coverage is complete and when it becomes effective.

Finally, please educate yourself and others about the health insurance marketplace and what it can offer you or others you know who may not have quality affordable health insurance; it could be peace of mind for years to come.

And if you are a Medicare beneficiary, what is most important to remember is that the Marketplace will not affect your Medicare coverage or benefits at all.The Marketplace is primarily for people who do not have health insurance, have had trouble obtaining coverage because of their health history, or who have individual policies now which are expensive.The Marketplace will make quality health insurance more available and more affordable for these people.


Department of Human Services

City of St. Louis

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