Understanding The Health Insurance Marketplace

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What Is The Health Insurance Marketplace?

 

The Health Insurance Marketplace, also known as the Marketplace, helps you find health coverage that fits your needs and your budget. You can compare plans based on price, benefits, and networks, to make the best coverage decision for you and your family. The Health Insurance Marketplace was established by the Affordable Care Act (ACA) to help individuals and families access affordable health insurance. While the federal government operates the Health Insurance Marketplace in most states, some states run their own marketplaces. All Marketplace insurance plans are offered by insurers like Anthem.

Who Qualifies For A Health Plan Through The Health Insurance Marketplace?

 

To be eligible for a health plan through the Health Insurance Marketplace you must:

  • Live in the United States.
  • Be a U.S. citizen or national (or be lawfully present).
  • Not be incarcerated.

 

Are Subsidies Available Through The Marketplace?

 

You may be eligible for free or low-cost coverage through premium tax credits, also known as health insurance subsidies. Most applicants will qualify for some kind of financial help.**‡

 

Premium tax credits are based on your income and family size (including yourself, your spouse, and anyone you claim as a tax dependent — even if they do not need coverage). Subsidies also consider the cost of health coverage in your state. If you are eligible, you may qualify for a health plan with a low or no cost monthly premium.*

 

 

How Does The Marketplace Work?

 

The Marketplace offers plans in four “metal” levels: Bronze, Silver, Gold, and Platinum. Metal levels differ only in how you and your insurer share the overall cost. Check for availability, as not all metal level plans are available in all areas.

Plan

Bronze

Silver

Gold

Platinum

What your plan pays

60%

70%

80%

90%

Your cost

40%

30%

20%

10%

What Does It Mean To Receive Coverage Through The Marketplace?

 

All Marketplace plans cover 10 essential health benefits:

  1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  2. Emergency services
  3. Hospitalization (surgery and overnight stays)
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
  6. Prescription drugs
  7. Rehabilitative services and devices (used to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision for children

 

While all Marketplace plans provide essential coverage outlined above, you can also select plans through your insurer that include more comprehensive coverage like dental and vision insurance.

 

 

When Can I Enroll In Marketplace Insurance?

 

You can enroll in a health plan through the Marketplace during the Open Enrollment Period, which typically runs between November 1 and January 15 annually, but actual dates can vary by state. If you miss Open Enrollment, there is another way you may still be eligible to apply for health coverage.

 

A Special Enrollment Period lets you apply for health coverage if you experience a life event like losing your existing health plan, getting married, or having a baby.

Need Help Finding A Health Plan Through The Health Insurance Marketplace?

Anthem is here for you and can help assist you in selecting a Marketplace health plan that fits your unique needs and budget.

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References

 

** Centers for Medicare & Medicaid Services: Health Insurance Marketplaces 2023 Open Enrollment Report (2023): https://www.cms.gov/files/document/health-insurance-exchanges-2023-open-enrollment-report-final.pdf.

 

‡ Subsidies are only available for Qualified Health Plans purchased through the Health Insurance Marketplace and State-Based exchanges. Anthem Insurance Companies, Inc., Blue Cross Blue Shield Healthcare Plan of Georgia, Matthew Thornton Health Plan, Inc., Healthy Alliance Life Insurance Company, Community Insurance Company, and Compcare Health Services Insurance Corporation offer such Plans through the Health Insurance Marketplace. HMO Colorado, Inc. offers such Plans through Connect for Health Colorado. Anthem Health Plans, Inc. offers such Plans through Access Health CT. Anthem Health Plans of Kentucky, Inc. offers such Plans through Kentucky Health Benefit Exchange (Kynect). Anthem Health Plans of Maine, Inc. offers such Plans through CoverME.gov. HMO Colorado, Inc. dba HMO Nevada offers such Plans through Nevada Health Link. HealthKeepers, Inc. offers such plans through the Virginia Insurance Marketplace. 

 

* Based on federal and/or state exchange requirements and subject to change. Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. are Qualified Health Plans that in certain geographic areas offer some health plans with a $0 (or $1 in Maine and Connecticut) premium option after subsidy is applied through the Health Insurance Marketplace or your state exchange. Anthem health plans with a $0 (or $1) premium option are not available in all areas and eligibility for these plans is based on federal annual income guidelines. Call us for information because not everyone will qualify. For example, singles earning up to $20,385, and couples earning up to $27,465 may be eligible. Family income eligibility varies based on number of family members.