Q&A for uninsured: How and when to enroll

Q: I’m uninsured. How much time do I have to enroll in a health plan?

A: If you want coverage that starts Jan. 1, you have until Dec. 23 (the deadline just got extended from Dec. 15). You need to pay by Dec. 31. If you just want to avoid being fined under the new rule that most Americans must carry health insurance, you have until March 31. In either case, don’t wait until the last minute.

Q: Is HealthCare.gov working now? What about the state exchanges?

A: It works! Well, sometimes. As for the state exchanges, it really depends on your state.

Programmers and network engineers have been working around the clock to fix the problems on HealthCare.gov, the federal website that serves three dozen states. Some issues have been mostly resolved.

If you live in Washington state or one of the 13 other states that created their own exchanges, things might go more smoothly. Many states are signing people up faster and with less hassle than the federal marketplace. But that’s not true across the board. There are big differences from state to state.

Q: I’m still having trouble getting through online. If I can’t get it to work by Dec. 23 what should I do?

A: You can try to apply by mail or over the phone. To sign up by mail you’ll need to fill out a paper application. To apply by phone, call 1-800-318-2596. The phone lines are open 24 hours a day, 7 days a week, but it’s been difficult to get through and there are delays in people calling back, so be prepared to keep trying. Many states have also designated organizations to work as “navigators” and they can help you review your options and help you sign up. Information about those in your local area can be found here: localhelp.healthcare.gov.

You can also go to a broker or directly to an insurance company, but it will be harder to compare prices.

Q: I heard that the enrollment dates for next year have been changed. What happened and what does it mean for me?

A: The change does not affect your 2014 insurance. The open enrollment period, which began Oct. 1, ends March 31.

The change is that the open enrollment period for 2015 insurance will be Nov. 15 through Jan. 15, 2015 (instead of Oct. 15 to Dec. 7, 2014).

Q: I’m overwhelmed by the amount of news about the health law. What do I need to know to make a decision about what insurance to buy?

A: Several points:

The good news is that comparing what different plans cover is simpler under the law. Every plan is required to provide coverage for 10 essential benefits, including emergency services, hospitalization, maternity and newborn care and prescription drugs.

Insurers are no longer allowed to charge more for pre-existing conditions but they will take into account your age, family size, where you live and whether you smoke when determining your premium. There are four main categories of insurance sold on the marketplace — bronze, silver, gold and platinum — depending on how much of the costs you are expected to share. A fifth type of insurance, catastrophic, is only available to those under 30 and those who can’t find coverage that is less than 8 percent of their income.

When looking at plans, don’t just consider the monthly premium. Some plans may charge low premiums but have high co-pays and deductibles, which matters if you go to the doctor a lot or fall ill. Remember, though, that the health law caps the amount of out-of-pocket expenses in a year to $12,500 for a family of four and $6,250 for an individual.

Many of the plans sold on the exchange exclude certain doctors or hospitals in order to keep costs down, so you should make sure that your current doctors and hospitals are included. If you are particular about seeing a certain doctor or being treated at a certain hospital, then you should be careful to study your options, because many hospitals and doctors are still in negotiations with insurers over their participation. Be ready to change plans at the last minute if a better one meets your needs.

Don’t forget that there’s still a private market. You may not be able to get subsidies if you buy outside the exchange, but you may find a plan that better meets your needs.

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