But while we all know the health insurance marketplace is supposed to help us increase access and decrease costs of coverage, do you know exactly how they work and what they will mean for you?
What is the health insurance marketplace?
The phrase “health insurance marketplace” or “health insurance exchanges” is becoming commonplace, but just because you know this program is coming doesn’t mean you really understand what it is or who it will affect.
The health insurance marketplace is where citizens and lawful permanent residents of the United States can go to compare prices and purchase health insurance plans that fit their individual needs and budgets.
In the health insurance marketplace you can compare coverage options. It makes it simpler for you to learn of all the options available in your area and also to compare plans based on price, quality of service, added benefits and other relevant details.
When you get insurance coverage through the marketplace, you may be able to qualify for lower premiums, depending on your income and the size of your family.
Remember that under the Affordable Care Act (also known as Obamacare), everyone who can afford it (a certain annual income) must get health coverage or they will have to pay a health tax penalty.
The application will also indicate if those applying for coverage qualify for lower monthly premium costs or lower out-of-pocket costs than what they are currently paying under private insurance.
All insurance plans in the exchanges are offered by private insurance companies that must offer the same basic coverage benefits. These companies cannot turn you away because of pre-existing conditions, nor can they charge you more because of a medical condition or any other reason.
Important points on health insurance marketplace
Knowing you can shop around for affordable, customized coverage is only the tip of the iceberg when it comes to the health insurance exchanges.
Other key points to the plan include:
- The health insurance marketplace is accessed through the Internet on state-specific websites or, if federally run, through healthcare.gov.
- Some health insurance exchanges are run by the federal government, and some others by your state. To find out if your state’s health insurance marketplace is state or federally run, visit healthcare.gov.
- Only a single application is needed for the process to help determine price, benefits and quality of offered insurance programs. It’s a simple and quick 4 step process. The process goes: Visit the marketplace site, open an account, apply for coverage, pick a health insurance plan, enroll.
- Help will be available through live Internet chat, in person, by phone, or through other Internet options and it is available in both English and Spanish (cuidadodesalud.gov)
- Depending on your needs and additional coverage you want to get, there are 4 categories of coverage on the health insurance marketplace: bronze, silver, gold, and platinum. Each category involves different out-of-pocket costs for you.
- All marketplace plans must offer the same set of core health benefits, which include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
- Premiums and out-of-pocket costs are directly related to the level of coverage selected. For example, someone with a gold plan will pay higher premiums than someone with a bronze plan, but the out-of-pocket costs for a gold member will be less than for a bronze member. Platinum plans have the highest monthly premium costs and the lowest out-of-pocket costs and are ideal for individuals who anticipate major medical expenses. People who frequently visit the doctor or need prescriptions are advised to select a gold or platinum plan.
- People with catastrophic plans through the health insurance marketplace cannot get lower monthly premiums or out-of-pocket costs on other private insurance policies.
- All insurance plans through the health insurance marketplace will offer free preventative services for: abdominal aortic aneurysm one-time screening, alcohol misuse screening, aspirin use, blood pressure screening, cholesterol screening, colorectal screening, depression screening, type 2 diabetes screening, diet counseling, HIV screening, immunizations, obesity screening and counseling, sexually transmitted infection prevention counseling, syphilis screening, and tobacco use screening.
- Because costs of coverage offered by the marketplace will be determined by the private insurance companies participating, individuals will not have access to a list of prices until October when open enrollment begins.
- While the health insurance marketplace is where currently uninsured people can go to enroll for coverage, individuals already covered may be eligible for savings if they switch to marketplace plans. The government anticipates people with the following income levels would be eligible for savings through the marketplace: Up to $45,960 for individuals; up to $62,040 for a family of 2; up to $78,120 for a family of 3; up to $94,200 for a family of 4; up to $110,280 for a family of 5; up to $126,360 for a family of 6; up to $142,440 for a family of 7; up to $158,520 for a family of 8.
- To be eligible for enrollment in the health insurance marketplace you must live in the United States; must be a U.S. citizen or lawfully present; and must not be incarcerated.
Open enrollment ends March 31, 2014.