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Your Obamacare questions answered

Posted at 12:24 PM, Jan 12, 2016
and last updated 2016-01-12 19:28:45-05

The Obama administration said Thursday 11.3 million people have enrolled for health law coverage with time still left in the sign-up season.

January 15 is the last day to enroll in or change plans for new coverage to start February 1, 2016. Open enrollments ends on January 31. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.

5 THINGS TO KNOW 

1. Who is it for? The Health Insurance Marketplace is for people who don’t have health coverage--through your job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source. MORE

2. How does a person apply? There are four ways to apply for coverage. MORE

3. Are you eligible to use the Marketplace? Here are the basic criteria:

  • Must live in the United States
  • Must be a U.S. citizen or national (or be lawfully present). 
  • Can't be incarcerated

4. Will you save money? It depends on two basic factors: If you qualify for a health insurance plan with savings based on your income. And, whether your state is expanding its Medicaid program--and, if it is, whether you qualify based on your income alone. 

As of January 2016, neither Kansas nor Missouri are expanding Medicaid. See this map for information on other states.

Healthcare.gov provides a tool to help you calculate your possible savings.

5. What do the plans cover? By law, all plans that are part of the Marketplace must cover:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
    Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

There are additional coverages provided. Click here to read more.

More about the state of the Affordable Care Act

Officials said enrollees are trending younger, and a growing share of returning customers has grown savvy about comparing insurance options to find the best deals. The administration is expecting a surge of young procrastinators to sign up near the Jan. 31 deadline for 2016 coverage. That could help hold down premiums the following year.

Leading the administration's tally was Florida, with more than 1.5 million signed up. California followed, with more than 1.4 million. About 8 in 10 customers are eligible for federal tax credits to bring down the cost of their monthly premiums. The administration appears on track to meet its target of having 10 million paying customers signed up at the end of this year.

In the 38 states served by the federal HealthCare.gov website, 29 percent of those signed up were new customers, a big priority. Overall, more than 1 in 4 was between the ages of 18 and 34, a coveted demographic since healthy young adults balance older customers who are more prone to medical problems.

Independent experts cautioned about drawing sweeping conclusions. In past years, there's been a significant drop-off between the initial sign-up numbers and those who actually followed through by paying their premiums.

Caroline Pearson of the consulting firm Avalere Health said the numbers on young adults represent a "modest improvement" from last year. "Bottom line, I think these numbers reflect a relatively consistent age distribution with where we have been historically," she said.

Another caveat: Administration officials said they are unable to tell how many new enrollees were previously uninsured. Since the health care law's big coverage expansion got underway in 2014, the nation's uninsured rate has come down to historically low levels. But a major independent survey also released Thursday indicated that accomplishment may be in jeopardy.