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10 Things to Know About Health Insurance Exchanges
PHOTO: Health insurance booklets

Your health insurance options are about to change.

Starting Oct. 1, Americans will be able to shop for coverage through national and state-administered insurance exchanges. But you only have six months to make your move.

Here are 10 things you need to know before open enrollment begins.


What happens on Oct. 1?

Starting Oct. 1, you can purchase health coverage through the Affordable Care Act health insurance exchange program. The coverage kicks in Jan. 1, 2014.

Your coverage options depend on where you live. Some states have exchanges run by the federal government, whereas others have their own exchanges or ones created in conjunction with the Obama administration. Either way, you can go to to see your coverage options and how much they cost.

You have six months to make a choice. If by March 31 you have no health insurance through the exchanges or your employer, you face a fine of 1 percent of your yearly income or $95 per person -- whichever is higher. The fee increases every year, rising to 2.5 percent of your yearly income in 2016 or $695 per person. That's on top of any health care costs.

What if I have health insurance through my employer?

If you have health insurance through your employer, you can keep it.

Job-based plans qualify as "minimum essential coverage." In other words, you won't be fined for not having health insurance if you're covered through your job. And because your employer pays a proportion of your premium, the coverage might be cheaper than the plans offered through the insurance exchange program.

You might still want to explore your options, but beware: Depending on the job-based coverage available to you, you might not qualify for certain savings offered through the health insurance exchange program. Check to find out.

What are the different types of health insurance?

All of the available health insurance plans will offer "essential health benefits" for emergency services, maternity, neonatal and pediatric care, outpatient and rehabilitation services, counseling and therapy, preventive and wellness services and prescription drugs.

Certain plans may offer additional coverage. You'll be able to compare plans in terms of coverage and cost starting Oct. 1 on

What is a "catastrophic" plan?

A catastrophic plan offers essential health benefits but has a higher deductible. Think of it as a safety net in case you have an unexpected accident or illness; you'll pay less up front but more if you need it. The plan does, however, cover three annual primary care visits and preventive services at no cost.

To qualify for a catastrophic plan, you must be under 30 years old or get a "hardship exemption" because you're unable to afford health coverage.

Can I get dental coverage?

Dental care is considered an essential health benefit for children, but not for adults.

Adults can choose a plan that includes dental coverage, or opt into a separate dental plan and pay an additional premium.

How much will health insurance cost?

Different plans have different costs depending on the coverage, but all of them must be approved by state insurance departments.

The pricing information will be posted Oct. 1 at, where you can compare coverage options and their costs. You might qualify for cost savings based on your income.

Will be my kids be covered?

Children can be covered by their parents' health insurance plan until they turn 26. If a dependent turns 26 during 2014, he or she can enroll in a new health insurance plan even after open enrollment closes March 31.

People under 30 can qualify for catastrophic coverage with a lower premium but a higher deductible.

What if I have a pre-existing condition?

Starting in 2014, you can't be denied health insurance or charged more because you have a pre-existing health condition, even if you've been refused coverage in the past.

The only exception is for grandfathered individual health insurance plans, according to But you can purchase a new plan through the health insurance exchange program Oct. 1 and get coverage for your pre-existing conditions.

What if I'm unemployed?

Your coverage options depend on your household income, not your employment status.

Depending on your income, you might qualify for Medicaid or the Children's Health Insurance Program. You might also qualify for lower monthly premiums and out-of-pocket costs through the health insurance exchange program. Check on Oct. 1 to find out.

What if I miss the March 31 deadline?

You have six months to choose the health insurance plan that's best for you and your family. If you miss the March 31 deadline, you could face a fine of 1 percent of your yearly income or $95 per person, whichever is higher.

But some life events, like the loss of a job, birth or a divorce, qualify you for a special enrollment period outside the October-to-March window. A 26-year-old dependent that loses his or her coverage through a parent's plan can also enroll throughout the year.

Do you have questions that we didn't answer? Ask them in the comments section.

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