Now Enter the Marketplace!

Ensuring Rural Family Health Insurance

As anyone with an ear on the news knows, the new health insurance marketplaces launched October 1. These state-based online health insurance marketplaces, a key feature of the 2010 Affordable Care Act [ACA], offer a singular opportunity for RuFES network members: You can now apply your place-based, RuFES-honed wisdom to steer rural families toward affordable health insurance and the medical care they need to EARN a living and KEEP their families moving toward economic success.

The critical need for rural families to tend to their health, and to be able to afford it, falls squarely in the RuFES framework. The RuFES vision of rural families getting ahead emphasizes jobs with family-supporting wages and benefits (Earn It, Goal 8), affordable basic goods and services (Keep It, Goal 8), and, of course: knowledge of and access to the wide range of public and private services that help reduce cost of living (Keep It, Goal 7).

tenpointsevenLack of coverage hits rural people and places hard. A larger proportion of the rural population than urban is uninsured and low income (9.9% vs 8.5%, according to the RUPRI Center for Rural Health Policy Analysis). That’s partly because rural families are less likely than urban dwellers to hold jobs that offer benefits. And outside their jobs, rural residents typically have fewer choices for affordable health insurance that covers their areas. Medical care for these families is thus often delayed until a crisis, and such crises can plunge rural families already living on the edge into job loss and significant debt.

The nonprofit Center for Rural Affairs analysis predicts that new law will likely reduce health insurance and medical costs for rural residents, who generally pay more for health insurance and have lower incomes than people who live in or near cities.

The new online marketplaces are designed to help uninsured Americans compare and buy plans – making health insurance and, ultimately health care, more accessible and affordable. With your help, currently uncovered rural residents can benefit from the marketplaces. Here are some basic facts and resources that can help you sort through the flood of information to start getting local families signed up!

Insurance Marketplace Basics: Get started now!

Tapping into ACA’s health insurance marketplaces or “exchanges” will help rural families shop for insurance and determine whether they qualify for lower cost health care or even free coverage.

Residents can now visit their state’s health insurance on-line marketplace to shop for health care policies offered by private companies.

What you can do to help rural families get enrolled in coverage:

  • Learn the basics.
    Prepare yourself to assist insurance exchange shoppers by visiting and bookmarking, the federal government’s go-to website on the new exchanges. By answering a few quick questions there, anyone can get a list of coverage options they may qualify for (specific plans and prices available Oct. 1), answers that can help them make good decisions, and a personalized checklist to help them get ready to apply. You also can sign up for email or text updates and even ask pros questions in a live chat.
  • Find your state’s Marketplace.
    Every state will have its own online portal for shopping for coverage. Find yours. Insurers and prices will vary by state, so getting to know your state’s options for various family situations is a good thing to do, so that you can advise others.
  • Call on the local experts.
    Some states have Federally-funded “navigators” or other qualified helpers to help families shop for coverage. Making a connection to your navigator(s) now and letting them know you will be working with local families can help build a relationship that might help. Find where you can get local help.

Stay on track! Know the deadlines for getting families enrolled:

  • Open enrollment started October 1.
    State marketplaces open for business.
  • Enroll by December 15 for coverage starting January 1.
    Families that are looking for insurance to start as soon as possible should complete the online enrollment process before December 15.
  • Open enrollment for 2014 ends March 31.
    After March 31, families can only get coverage if they have a qualifying life change like a job loss, birth, or divorce. Families must enroll in some form of coverage by March 31 (if they are not eligible for Medicare, Medicaid or insurance from an employer) to avoid paying a tax penalty.

Exceptions: Applications for Medicaid or Children’s Health Insurance Program (CHIP) can be submitted any time – and coverage can begin immediately.

Know how ACA changes can make things better for your families:

  • Families shopping for coverage in the Marketplace cannot be denied coverage because of pre-existing conditions. This protection already applies to children but will extend to adults on January 1, 2014.
  • Every private health insurance plans offered in the Marketplace must offer the same set of essential health benefits, many of which were not covered by basic plans in the past – including ambulatory patient services, emergency services, hospitalization (such as surgery), maternity and newborn care, mental health and substance use disorder services, prescription drugs and more!
  • Insurance in the Marketplace is more affordable for low-income and middle-income families – individuals earning less than $45,960, or a family of four earning less than $94,200 – through the use of advance tax credits that can be applied directly to the premiums.

Find additional resources to help you help rural families and businesses with ACA:

  • The Kaiser Family Foundation offers loads of information for consumers and business owners, including detailed profiles of each state marketplace and a calculator to help uninsured people determine eligibility for tax credits or Medicaid.
  • The Center for Rural Affairs has a range of information about a wide range of aspects of ACA, including good information for small business owners in rural areas.
  • The Affordable Care Act issue group on RuralXChange is a one place to access and share resources and to talk with others about ACA changes to health care.

Do you have a question about how the Affordable Care Act works or how it might affect rural families or businesses in your area? Live chat with the folks over at or send us an email (!

RuFES is a project of the Annie E. Casey Foundation and the Aspen Institute Community Strategies Group.
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