Outside the Marketplace, purchasing health insurance year-round may save money through premium tax credits or other savings measures tied to income. New York Medicaid or Children’s Health Insurance Program can also be enrolled in at any time if eligible for a Special Enrollment Period.
What is the Marketplace?
The Health Insurance Marketplace is an essential component of the Affordable Care Act (ACA). As an online tool, it enables individuals and families to quickly locate affordable ACA-compliant health coverage. Federal subsidies make premiums more manageable; individuals can use either their state marketplace or the Federal Marketplace to compare plans and obtain coverage.
The Marketplace provides access to affordable employer-based coverage or Medicare for people without access. Individuals can browse and enroll in health plans that best meet their needs, budget and preferences – as well as easily assess whether they qualify for financial help like premium and cost sharing subsidies – through this simple platform. Normally open from November 1 – January 15 each year, this period may also allow people experiencing life events such as job loss or birth to apply outside this period.
Health plans offered through the Marketplace must provide all 10 essential health benefits, including doctor visits, hospital stays, emergency rooms visits, prescription drug costs and preventive services. In addition to these basic requirements, many Marketplace plans also include extras like dental and vision coverage; plans can also be divided into four “metal” levels with Bronze being the least costly plan and Platinum the most costly.
Use the Marketplace to compare plans based on price, coverage and networks. Plus you can use your ZIP code to see if you qualify for health insurance subsidies! Moreover, an “authorized representative” may help with the application process – simply provide their contact info such as email and phone number when nominating one.
How do I get Marketplace coverage?
The Marketplace (often known as Obamacare Marketplace or health insurance exchange) is an online “shopping mall” designed to enable users to quickly view and compare different health insurance plans available to them and discover any eligibility for financial aid towards covering their coverage costs. All plans offered through the Marketplace come from private health insurers with four metal levels available – Bronze, Silver, Gold and Platinum each providing different combinations of benefits and costs.
Enroll in a plan during the annual open enrollment period, typically running November through December. However, in case of qualifying life events such as pregnancy or divorce, enrollment and changes can often take place outside the open enrollment period.
If you have Medicare Part A and qualify for premium-free Part B, it is generally illegal for you to buy Marketplace plans (or any type of subsidized health coverage) simultaneously with Medicare plans unless doing so would incur penalties for not providing minimum essential coverage.
Joan will become eligible for Medicare in seven months and currently has a Marketplace plan; during that time she can keep it until it starts, though any financial assistance such as advance premium tax credits and cost-sharing reductions that she was receiving to cover Marketplace premiums (e.g. advance premium tax credits and cost-sharing reductions) will cease. For any inquiries related to your eligibility for Medicare Marketplace plans you can reach out to one of their help centers; alternatively you may choose someone as your authorized representative who can answer any queries you may have and make decisions for you (click here for more info on choosing such a person).
Can I get Marketplace coverage if I already have Medicare?
As long as you have Medicare Part A, then the Affordable Care Act and don’t need a Marketplace plan, and anyone trying to sell one may violate federal law by selling one to you anyway.
The Marketplace facilitates competition among private insurers by offering them in one central location where individuals without access to employer-sponsored coverage can shop and compare plans, and obtain financial assistance such as premium tax credits and cost-sharing reductions based on income eligibility. If your life or income circumstances change, be sure to inform the Marketplace so you receive appropriate benefits; enrolling in an employer plan won’t cause you to cancel Marketplace coverage, though savings will end and any differences owed must be paid back through your federal tax return for that year.
Be mindful that the Marketplace does not provide Medicare supplement (Medigap) and Advantage plans (HMO and PPO). If you don’t currently have one of these policies, make sure you sign up during open enrollment period in 2019. Otherwise, penalties could apply when enrolling later for Medicare Part D drug plans.
Once you enroll in Medicare Part A, your premium subsidy will end. Usually this happens three months prior to reaching 65. If you already have a Marketplace plan in effect, contact it for instructions on how to terminate its coverage so it doesn’t renew automatically after Medicare coverage begins.
Can I get Marketplace coverage if I have a job-based plan?
If you currently have job-based health insurance, changing to a Marketplace plan might be possible; however, premium tax credits or savings may likely not apply. When applying, we will evaluate if the current coverage meets certain standards such as affordability and quality; most large employers’ plans already do meet these criteria.
If your employer provides COBRA continuation coverage, you may be able to continue your coverage for 18-36 months after losing or departing their company. In such an instance, you’ll likely have to pay the full monthly premium, including employer contributions plus an administrative charge of 2 percent; at that point you’d need to enroll again during open enrollment on the Marketplace.
The Marketplace provides plans that comply with ACA, meaning there will be no annual or lifetime benefit caps, and all ten essential benefits will be covered, such as doctor visits, hospital care, emergency services, mental health/substance abuse treatment and prescription drugs. Federal subsidies such as premium tax credits and cost-sharing reductions may help lower monthly costs even further.
All Marketplace plans must offer comparable benefits to most employer-sponsored health plans, including doctor visits, outpatient hospital care, emergency services and mental health and substance use treatment. In addition, some plans provide preventive health services such as screenings for cancer, heart disease and diabetes.
If you already have a Marketplace plan and receive an offer of job-based health insurance (HIP), cancelling it will prevent dual billing and the repayment of subsidies that were given through Marketplace plans. Log into your Marketplace account and choose “Report a Change.”
Can I get Marketplace coverage if I’m eligible for Medicaid or CHIP?
The Marketplace can help you shop for health insurance that fits within your income. In some cases, cost-sharing assistance based on income may make Marketplace plans easier to afford. To see if cost-sharing assistance might help make a plan more affordable for you enter your zip code into the View Plans Now section above and if any family members qualify for Medicaid or CHIP we’ll forward their information directly to their state agencies who’ll then reach out about enrollment opportunities.
The Marketplace provides plans with comprehensive coverage that cover doctor visits, hospitalizations, prescription drugs and more – similar to what employers may provide as employer-sponsored insurance plans.
Marketplace coverage can be acquired during the annual Open Enrollment Period, running from November 1 through December 15 each year. Major life events like getting married or giving birth qualify you for Special Enrollment Periods that enable earlier enrollment into coverage through Marketplace plans.
The Affordable Care Act created the Health Insurance Marketplace, or Exchange, as an organized market for individuals and families to shop for the health coverage that best meets their needs and budget. The Exchange offers certified insurers as well as consumer protections and in-person help services; additionally it can help individuals determine eligibility for Medicaid/CHIP programs or Premium Tax Credit financial assistance to make Marketplace plans more cost effective.
Individuals looking for Marketplace health insurance have four metallic tiers from which they can select a plan: Platinum, Gold, Silver and Bronze. Each plan tier differs by both premium amount and out-of-pocket costs such as copays for doctor visits or prescription drugs.
