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Health Insurance Basics

Health Insurance Marketplace: Overview, Plans, & Coverage Options

February 26, 2018

The risks of having no coverage are high, including poorer health and financial adversity. If you understand those risks, yet are uninsured, then perhaps now’s the time to start thinking about getting coverage. How to start? Many states have healthcare insurance marketplaces, but is also a centralized insurance marketplace and a good place to begin investigating your insurance plan options.

One quick piece of advice: Understanding the marketplace can be daunting, but dip your toe in the water, and it warms up quickly.

What is the Insurance Marketplace and Who Oversees It?

The Department of Human Services is the federal agency that oversees the Centers for Medicare and Medicaid Services, and also administrates the insurance marketplace.

The insurance marketplace is a program that helps you find affordable health plans. You can compare competitively priced plans to pinpoint one that’s best for you.

The marketplace is a way to purchase insurance without the help of a broker, with easy to us tools that help you choose a plan, including the ability to see if you are eligible for subsidies (financial help). To qualify for a subsidy, you must meet the income requirements and purchase your health insurance through the marketplace. You can also use the marketplace to apply for Medicaid and Children’s Health Insurance Program (CHIP) if you qualify.

Who is Eligible for the Health Insurance Marketplace?

The health insurance marketplace is for individuals and families that need health coverage because they don’t qualify for an employer-sponsored plan. You also have a choice, if you are not subsidy eligible, to purchase plans directly through the health insurance provider, or through a broker. However subsidy-eligible consumers must purchase their plan through the marketplace to take advantage of the cost-assistance. Once you provide the information, you can easily compare plans.

What Type of Marketplace Insurance Plans Are There?

Whether you buy on the marketplace or through an insurance carrier, you will find that plans are grouped by “metal” categories: Bronze, Silver, Gold, and Platinum. Bronze has the lowest premium and highest cost for care, and Platinum has the highest premium and lowest cost for care. If you are subsidy eligible, you will save money, no matter which plan you pick. So, while you’re researching plans, have your most recent tax returns handy.

When selecting a plan, you’ll also want to check which doctors are in the plans you’re considering. Some plans allow you to use almost any doctor or health care facility, while others limit your choices or charge you more if you use providers outside its plan’s network. If you have a doctor you’d like to see regularly; it’s probably best to ensure that he or she is in the plan you want before making a final choice.

When is the Marketplace Enrollment Period?

Affordable Care Act health plans are available on during a period called open enrollment. Open enrollment allows individuals looking for a health plan to shop and purchase an individual health plan beginning in November of each year, but does close in December in most states. However, if you have a qualifying event, you can purchase ACA plans during the Special Enrollment period.