The Health Insurance Marketplace

Dec 29, 2023 By Susan Kelly

You may purchase a plan via the Health Insurance Marketplace if you don't have insurance from your employer, Medicaid, Medicare, CHIP, or any other source. Other sources of health insurance include Medicare and Medicaid. You must satisfy all of the following requirements to be qualified to purchase health insurance via the Marketplace:


  • You need to reside in the United States.
  • You need to be a citizen or national of the United States
  • Should never be put behind bars.
  • If you already have Medicare coverage, you cannot utilize the Marketplace to purchase a health or dental plan since you are ineligible.


The Affordable Care Act (ACA) of 2010, most often referred to as Obamacare, was the legislation that led to the establishment of the Marketplace (or Exchange). Most individuals can apply for and enroll in health insurance via the marketplace operated by the federal government (you may access it at HealthCare.gov). However, 17 states and Washington, DC have also established their exchanges for residents.



When to Submit Your Application for Coverage


If you experience a qualifying life event, you might become eligible for a special enrollment period. That occurs if any of the following takes place:


  • You are no longer eligible for health coverage (such as from losing your job).
  • Either you marry, or you end yourself divorced.
  • You either give birth to a kid or decide to adopt one.
  • You relocate to a new region, which may include changing your ZIP code or county.
  • You have experienced a shift in your income, which will affect your insurance coverage.


If you don't have an exemption, you must look for, apply for, and purchase a health insurance plan during the open enrollment period. This often takes place in the fall, between November and December.


Getting Started in the Marketplace


Visit HealthCare.gov or the website specific to your state to get started. In any case, you will be provided with a concise analysis that contrasts the various strategies that are open to you.


You can select health insurance from one of four grades in the database: bronze, silver, gold, or platinum. When it comes to your monthly health insurance expense, the bronze plans are the ones that will cost you the least. However, their deductibles, copayments, and coinsurance are the most expensive in the market. The Platinum plans offer the highest monthly fees but the lowest prices for additional services and features.


Choosing between these plans might be difficult, so before you make a choice, you should take your time, learn as much as possible about the perks offered by each of the available plans, and think carefully about the trade-offs involved.


You will find out throughout the enrolling process if you are qualified for an advance premium tax credit or a cost-sharing reduction. If you are qualified, you will be informed of the amount of money you may save. You must purchase your plan via the Marketplace if you are eligible for discounts.



What if I already have a Marketplace plan?


Don't be concerned! Even if you already have a plan, you can take advantage of the newly introduced plans at cheaper costs. Logging into your account and resubmitting your application is all that is required of you to see the updated eligibility results that include the additional credit for the tax refund. Your eligibility results will be shown immediately, so you don't need to hang around and wait.


If your findings reveal that you are eligible for more tax credit, all you need to do is reselect your existing plan. The modifications will go into effect to reduce your premiums for the remaining time in 2022. The only potential drawback to this is that your deductible could be reset, but the specifics of your plan will determine this. Before making any changes to your coverage or adding a new person to your family, you should verify this information with your insurance provider by calling them.


Choosing Catastrophic Coverage


There is a possibility that catastrophic plans may be featured as one of the available plan choices when you apply online. If you are under 30 years old or qualify for a hardship exemption because you cannot afford health care, you may be eligible for a catastrophic plan. You will not be eligible for a catastrophic plan if you do not meet either of these requirements. This is established throughout the application process and depends on the number of people in your household and how much money you make.

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