Health Insurance Marketplace


 Are You Ready? The Health Insurance Marketplace is Coming

No doubt you’ve been starting to hear about the new Health Insurance Marketplace, a key part of the health care law that will be open for business on October 1st, 2013. But you probably still have questions. Like "What is the Marketplace?" and can you really get health insurance? Well, we’ve got answers.

The best place for the latest, most accurate, information on the Marketplace is the updated website, HealthCare.gov. At the site, you can learn what it is, who can apply for insurance, how to get insurance, how to lower your costs, and more. If you own a small business, there’s information for you, too.

Starting this fall, the Marketplace will help you find health insurance that fits your budget and meets your needs, with less hassle.

No matter where you live, you may buy insurance from private health plans that cover a comprehensive set of benefits, including doctor visits, hospital stays, preventive care, and prescriptions. And plans in the Marketplace must treat you fairly; they can’t deny you coverage because of a pre-existing condition.

With a single application, you can also see if you qualify for Medicaid or the Children’s Health Insurance Program, or savings you can use right away to lower your health insurance premiums.

Enrollment Starts October 1, 2013 Visit HealthCare.gov to Get Ready

HealthCare.gov is your best source of information about the Marketplace. You can read information that pertains to you, print checklists, and watch videos to help you get ready to apply and enroll.

You and your family can explore every qualified health plan in your area, and fill out an application when you’re ready. You’ll be able to take control with better information, including details about benefits and prices presented in clear language you can understand, so you’ll know what your premiums, deductibles, and other costs will be before you make a choice.

Once you’ve decided on a plan, you don’t need to go anywhere else. Starting in October, you’ll be able to enroll in the Marketplace directly for coverage that begins as soon as January 1st, 2014.

Want help or need more information?

As you explore your options on the Marketplace, you may want to get some help. You can participate in an online web chat on the website; or call a toll free number, 1-800-318-2596, to speak with a trained customer service representative; and there will be people in your local communities who can give you personal help with your choices. These people can be Navigators, In-person Assisters, Certified Application Counselors (CACs) or Brokers and Agents. They are trained individuals or organizations that are available to help individuals and small businesses and their employees as they look for health coverage options on the marketplace. These people are unbiased and their services are free for consumers.

In some states Agents and Brokers may also be able to help you. However these entities may receive payments and commissions from particular health insurers and therefore may only be able to answer questions and sell plans from specific health insurers only.

Frequently Asked Questions

To be eligible for the tax credits and subsidies, which are not available outside the Marketplace.

If you meet the following criteria, you are eligible for coverage through the Marketplace:

  • live in the United States
  • are a U.S. citizen or national (or are lawfully present)
  • not currently incarcerated

Yes, you can get coverage through the Marketplace. By law, no one can be refused health care coverage on the basis of pre-existing diseases like heart disease and diabetes.

No, the Marketplace will not sell policies that provide supplemental coverage for people on Medicare. Additionally, if someone has coverage through their employer, Medicaid or the VA, you need not apply for coverage through the Marketplace unless you lose that coverage for some reason. The Marketplace will not affect the benefits you receive under your current plan. For more information, click here.

Eligible candidates can apply for coverage in four easy steps:

  • 1. Set up an account
  • 2. Fill out the application
  • 3. Compare options
  • 4. Enroll

By law, qualified health plans (QHPs) in the Marketplace are required to cover the following:

  • Outpatient care you get without being admitted to a hospital (called ambulatory patient services)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after the baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy)
  • Prescription drugs
  • Services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills (called rehabilitative and habilitative services and devices)
  • Laboratory services, preventive and wellness services and chronic disease management
  • Pediatric services

Depending on your state and the health plan, more services may be covered.

Plans are presented as bronze, silver, gold and platinum categories on the Marketplace and vary by premium (learn more about the four categories of plans here). Additionally, some plans will offer catastrophic plans for adults under the age of 30 years and people with very low incomes (learn more about catastrophic plans here).

Navigators provide in-person education in the language of your choice as long as the ACA is in effect. They can help you determine your eligibility, enroll, and select an appropriate plan. They can provide referrals to other consumer resources.

In-person Assisters provide a wide range of in-person consumer assistance similar to Navigators.

Certified Application Counselors (CACs) may provide information on Insurance Affordability Programs (IAPs) and coverage options, and may assist individuals in buying coverage.

Implemented as is, the Affordable Care Act (ACA) will require you to have minimum health insurance coverage or pay a penalty. These penalities are waived if you:

  • are on Medicare, Medicaid or other federal programs
  • have been uninsured for fewer than three months of the year
  • have very low incomes or qualify for Medicaid, but live in a state that has not expanded Medicaid

To see the penalty you may have to pay for choosing to remain uninsured, click here.