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What Is Health Insurance Through A Marketplace

What If I Work Part

What is the Health Insurance Marketplace?

If you work part-time and can’t get coverage from your employer, you can purchase a plan through the Marketplace. Depending on your income level, you might be eligible for lower policy premium. However, if you can get health coverage from your employer, you can still buy insurance through the Marketplace but you might not qualify for a premium tax credit and other savings based on your income.

More Frequently Asked Questions About Health Insurance Marketplaces

You are not required to buy coverage through the marketplace. There is no longer a federal penalty for not having health coverage . And even when there was a federal penalty, people could choose to purchase their coverage off-exchange instead of buying a plan through the marketplace .

But if you dont buy your coverage through the exchange, you cannot obtain premium tax credits or cost-sharing reductions, even if youd otherwise be eligible for them. This is one of the primary reasons people shop in the marketplace, as full-price individual health insurance premiums would simply be too costly for most people.

In each state, the health insurance marketplace allows consumers to select from among a variety of private health insurance companies that offer different qualified health plans .

All qualified plans offered for sale in the marketplace must be ACA-compliant meeting standards established and enforced by the federal government. So when a person shops in the health insurance marketplace, they can be sure that the participating insurers will not use medical underwriting or exclude pre-existing conditions. All of the available plans will cover the ACAs essential health benefits without annual or lifetime benefit caps.

How Can I Get More Information

For more information about your coverage offered by your employer, please check your open enrollment materials, which include the annual Health Benefits Decision Guide and the online health plan’s summary plan description . You may also contact your health plan or your benefits/payroll/personnel office. Retirees may contact ETF.

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

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How States Approached The Health Insurance Marketplace Decision

Early adopters A handful of states jumped into exchange planning shortly after the ACA passed. California was the first state to pass legislation authorizing an exchange doing so in September 2010. Colorado, Connecticut, Hawaii, , Oregon, Vermont, and Washington all authorized state-run exchanges in 2011. Massachusetts and Utah were operating exchanges prior to ACA, and both began moving ahead on changes needed to comply with ACA requirements .

Active resisters A number of states mostly led by Republican governors adamantly opposed to the ACA said early and often that they would not implement state-run health insurance exchanges. Alaska, Florida, Louisiana, South Carolina, and Texas are all examples.

Alaska and Louisiana have since elected Democratic Governors who have expanded Medicaid, but with HealthCare.gov running smoothly and efficiently by mid-2014, and with the significant financial costs involved, there was no longer much incentive for states to establish their own exchanges.

Indeed, Medicaid expansion is a much more important aspect of state-based ACA implementation at this point, since HealthCare.gov provides the same private plan options and subsidies that enrollees would have under a state-run exchange, while states continued rejection of federal funding for Medicaid expansion means that 2.2 million people have no realistic access to coverage .

Are All Health Insurance Marketplaces Run By The Government

Guide Employees Through Public Health Insurance Marketplace

No. Both the government and private companies run health insurance marketplaces. There are three types of marketplaces:

  • State government marketplaces. Depending upon where you live, your state may run a health insurance marketplace.
  • Federal government marketplace. Not all states have their own marketplace. People who live in states that do not have a marketplace can use the federal governments health insurance marketplace.
  • Private marketplaces. Private health insurance exchanges like eHealth offer a convenient way for people from all states to buy marketplace and alternative health insurance plans. If you choose to get an ACA plan from eHealth, it will include the same essential Obamacare benefits you would get on a state or federal health insurance marketplace. If you are entitled to federal subsidies, you will get the same amount of subsidies when purchasing insurance on the private marketplaces as you would on the government marketplaces.
  • Keep reading to learn about more differences between private exchanges like eHealth and the government Marketplace.

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    Do I Have To Use The Marketplace If I Dont Have Health Insurance

    NOTE: Remember the fee is reduced to $0 in most states, so the information on the fee below is mostly for historical purposes.

    The ACAs individual mandate, says that most legal residents in the U.S. must obtain health coverage, an exemption or pay a fee after 2014. Trumps rollbacks have made it uncertain whether this provision will continue to be enforced.

    If you dont get health insurance will theoretically have to pay 95 dollars or 1 percent of their annual income, whichever is higher. That amount will rise each year until it hits $695 or 2.5 percent by 2016. .

    If you have health insurance already, then you are most likely in the clear. If you make less than 400% of the Federal Poverty Level, you will most likely qualify for free or low-cost health insurance through the marketplace, so it is advised that you at least fill out an application. The marketplace is an option and not a requirement. You may buy private insurance through a broker or directly from a provider or obtain any other type of minimum essential coverage which includes most common health insurance types. See our Guide to Health Care Plans here.

    When Will I Know My Options

    Once your application is submitted, you will receive an Eligibility Notice. If you applied online, this may be provided the same day in the Messages section of the account you created. If you are eligible for a Marketplace plan, you can review your options immediately and choose a plan. If you or your dependents are being considered for Medicaid or CHIP eligibility, it may take several days at a minimum to receive notice whether you and/or your dependent qualify for those programs. This can vary by state, and you may have to wait for a response by mail or follow up with your state Medicaid office.

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    How To Sign Up For The Health Insurance Marketplace Website

    Here are the official directions for signing up for health insurance through healthcare.gov.

  • Set up an account. First, youll provide some basic information. Then choose a username, password, and security questions for added protection.
  • Fill out the online application. Youll provide information about you and your family, like income, household size, current health coverage information, and more. This will help the Marketplace find options that meet your needs. Important: If your household files more than one tax return, call the Marketplace Call Center at 1-800-318-2596 before you start an application. This is a very important step. Please dont skip it. Representatives can provide directions to make sure your application is processed correctly.
  • Compare your options. Youll be able to see all the options you qualify for, including private insurance plans and free and low-cost coverage through Medicaid and the Childrens Health Insurance Program . The Marketplace will tell you if you qualify for lower costs on your monthly premiums and out-of-pocket costs on deductibles, copayments, and coinsurance. Youll see details on costs and benefits to help you choose a plan thats right for you.
  • Finding Your Health Insurance Exchange

    Enrollment now open for plans through Kentucky’s health insurance marketplace

    Your state may run its own health insurance exchange such as the one run by California, Covered California. Or, your state may have opted not to create a health insurance exchange, or to create an exchange but use the federal enrollment platform. In that case, residents use the federal government’s exchange at HealthCare.gov.

    The following states have their own enrollment websites, although you can get to them by starting at HealthCare.gov and clicking on your state or entering your zip code:

    In every state, enrollment in the exchange is limited to an annual open enrollment window and special enrollment periods triggered by qualifying events.

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    What Is The Aca Health Insurance Marketplace

    The Health Insurance Marketplace is a platform that offers insurance plans to individuals, families, and small businesses. The Affordable Care Act established the Marketplace as a means to extend health insurance coverage to millions of uninsured Americans. Many states offer their own marketplaces, while the federal government manages an exchange open to residents of other states.

    Who Can Use The Exchanges

    All U.S. citizens and legally present residents who are not imprisoned and not enrolled in Medicare are eligible to purchase a health plan in the exchange in the state in which they live. Undocumented immigrants cannot enroll in coverage through the exchanges, even without premium subsidies.

    In some states, small businesses can also purchase coverage in the exchange . Note that in states that use HealthCare.gov’s small business exchange, the exchange is no longer handling enrollment, and is having businesses enroll directly with insurers instead. Some of the state-run exchanges are also using this approach, so on-exchange availability of small group health coverage is fairly limited.

    As a result of the Grassley Amendment in the ACA, Congress members and their staffers are required to obtain coverage in the exchange. To accommodate this requirement and ensure that Congress and staffers didn’t lose their employer premium contributions, the government created a workaround that lets Congress and staffers enroll in small group plans through the state-run exchange in the District of Columbia .

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    What Is The Individual Health Insurance Marketplace

    Also known as the health insurance exchange, the marketplace is a public, online store where you can shop for both individual and family health insurance plans in your state.

    Through this shopping portal, you can compare the prices, quality and benefits of many health plans in one place. Plus, its a true marketplace, with many different insurers offering one or more plans to fit different needs and budgets.

    The look and feel of your health insurance marketplace depends on the state where you live. Some states have their own marketplace, like Minnesotas MNsure. Other states use the federal marketplace at HealthCare.gov

    You can purchase any plan in the marketplace during the yearly Individual Open Enrollment Period.

    How Do You Calculate Your Health Care Subsidy

    Three Carriers to continue offering Insurance through the Marketplace ...

    The amount of premium tax credit available is determined by subtracting your required contribution from the actual cost of a benchmark Silver plan.

    For example, if the annual cost of a Silver plan is $6,000 and you earn 300% of the federal poverty level of $40,770, your required annual premium contribution for essential health services would be 6% of $40,770, or 2,446.20 .

    As there are a lot of variables in calculating your health care subsidy, it helps to use a subsidy calculator:

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    Part B: Information About Health Coverage Offered By Your Employer

    Note, you will need to take the document, that is available via the link at the end of this paragraph, to your benefits/payroll/personnel office for completion if you choose to apply for coverage through the Marketplace. This document contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. .

    If You Get Health Insurance Through The Public Marketplace A Midyear Review Can Help Avoid A Tax Surprise


    It is a good sign that your income is higher than you anticipated.

    If you get your private health insurance through the public marketplace, that extra cash could mean an unexpected tax bill. A mid year income check can help.

    If you receive premium subsidies through the marketplace, you may not be entitled to as much aid as you thought. At tax time, any overage needs to be paid back.

    Workers could see an average raise of 4.1% in the next five years.

    The director for tax policy and advocacy with the American Institute of CPAs said that you should go into your account and change your estimate.

    You might get bigger monthly subsidies if you report a drop in income. Marriage or a new member of your household can affect the size of the aid, so make sure your account reflects that.

    Cynthia Cox is a vice president at the Kaiser Family Foundation and the director of theAffordable Care Act program.

    If you want to change your information, you can either call the exchange or go to your online account. If you used an insurance agent or broker to sign up, you should be able to get assistance from them as well.

    Almost all of the people who enroll in private health insurance through the public marketplace are getting subsidies. People who get coverage through healthcare.gov or their state’s exchange are those who can’t get workplace insurance or aren’t eligible for Medicaid or Medicare.

    Cox hopes that the worst kinds of surprises won’t happen as much this year.

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    What Is The Difference Between The Marketplace And Private Insurance

    Private insurance, sometimes referred to as a private health exchange, is similar to the Marketplace in that several plan options can be easily compared through an online portal. These coverage options are typically offered through an insurance broker or a single private insurance company that offers multiple plan options for employers or private individuals.

    However, the plan options offered through a private exchange are not required to meet all of the standards set forth in the ACA. While many private health insurance plans do cover the 10 essential health benefits and meet other minimum standards of the ACA, there are also no government subsidies offered on plans issued through private health insurance exchanges.

    Small Business Health Options Program Marketplace

    Enrollment Period Opens To Buy Health Insurance Through Federal Marketplace

    The Small Business Health Options Program Marketplace – also known simply as SHOP – helps small businesses provide health coverage to their employees. While the SHOP Marketplace was previously only open to employers with 50 or fewer full-time equivalent employees, starting in 2016, some states may make the SHOP Marketplace available to businesses with up to 100 employees. If you have more than 50 employees and don’t know if you can use the SHOP Marketplace, contact your state Department of Insurance or the SHOP Call Center.

    The SHOP Marketplace – which is also open to non-profit organizations – allows you to offer health and dental coverage that meets the needs of your business and your employees. SHOP offers flexibility, choice, and online application and account management. You can enroll in SHOP any time of year. Theres no restricted enrollment period when you can start offering a SHOP plan.

    Businesses that offer health coverage through the SHOP Marketplace may be eligible for the small business health care tax credit.

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    What Is The Health Insurance Marketplace And How Can I Use It

    The Health Insurance Marketplace is still a relatively new program in the U.S., as the first official plan year started in 2014. The Marketplace is intended to provide Americans withincreased access and affordability to quality health insurance plans. If youre thinking about whether to purchase health insurance or shop for a new plan on the Marketplace, then you may like many people still have questions. Maybe youre not sure what exactly the Marketplace is. Maybe youre wondering if youre eligible, or if you can save money on health insurance using one of the available plans.

    This Money Chat will provide a basic overview of what the Marketplace is, who can use it, and how to apply.

    What If I’m Pregnant And Want To Buy A Marketplace Plan

    Under Obamacare, preexisting conditions are covered, including pregnancy. Maternity care and childbirth are considered essential health benefits, which means all Marketplace health plans must cover themâeven if you were pregnant before your coverage begins. Some grandfathered individual health plans, though, don’t have to cover pregnancy and childbirth.

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    What You Should Know

    • Advance Premium Tax Credits

      An APTC is a federal tax credit that is used to lower the monthly cost of a Marketplace health plan. Eligibility for an APTC is available for those with a household income between 100 percent to 400 percent of the federal poverty level. The federal poverty level is adjusted annually. The Marketplace will determine your eligibility for an APTC.

      If you are eligible and use a Marketplace APTC to lower your monthly premium payment, you will have to reconcile the credit when you file your federal taxes. For additional information and a step-by-step guide to reconciling your APTC, visit www.healthcare.gov.

    • Cost-Sharing Reductions

      CSRs allow you to save money when you receive health care services. A health plan with a CSR lowers the amount you have to pay for out-of-pocket costs like:

    • Deductibles
    • Co-insurance
    • Out-of-pocket maximum

    To qualify for a CSR, you must purchase a silver level health plan on the Marketplace and have a household income between 100 percent to 250 percent of the federal poverty level. The federal poverty level is adjusted annually.

  • Marketplace Participation

    Not all health insurers choose to participate in the federal Marketplace. Prior to selling plans on the Marketplace, an insurer’s qualified health plan and rates must be certified by DIFS and the federal government.

  • Platinum Level – These plans must cover 90 percent of expected health care costs and you are financially responsible for the remaining 10 percent.
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