Health Insurance Marketplace – General Information for Consumers
What is the Health Insurance Marketplace?
The Marketplace is a competitive marketplace where people and small businesses can shop for and buy private health insurance. With one application, you can find out if you qualify for health plans in the marketplace, and other programs like Medicaid and the Children’s Health Insurance Program (CHIP), tax credits, and cost-sharing reductions
What is the difference between the Marketplace and the traditional insurance market?
The Marketplace will improve today’s broken insurance markets for consumers and small businesses. It will achieve this by:
- More Choice. You will have a choice of health plans to fit your needs.
- More Competition. The Marketplace will make it easier for you to compare plans on the basis of price, quality and benefits. This gives insurance companies incentives to offer better products at lower prices than their competitors.
- More Clout. The Marketplace will give millions of individuals and small businesses the same purchasing power as big businesses by bringing people together, lowering costs by spreading the cost of insurance across a larger group of people and allowing insurance companies to reduce prices.
What does the Marketplace mean for consumers?
The Marketplace is a single place where consumers, including students, can apply for and enroll in health insurance coverage that’s right for them and their families. Consumers can compare health plans with similar coverage levels and learn if they qualify for help paying for health care costs through tax credits and cost-sharing reductions. The Marketplace makes it easier for consumers to keep their coverage, even if income and employment changes make them ineligible for other programs like employer-sponsored insurance, private insurance tax credits, Medicaid, or the Children’s Health Insurance Program (CHIP).
What if I can’t afford insurance?
When you fill out a Marketplace health insurance application, you’ll find out if you can get lower costs on monthly premiums or out-of-pocket costs, or get free or low-cost coverage. Most people who apply will qualify for lower costs of some kind. You can save money in the Marketplace in three ways, depending on your income and family size:
- You may be able to lower costs on your monthly premiums when you enroll in a private health insurance plan.
- You may qualify for lower out-of-pocket costs for copayments, coinsurance, and deductibles.
- You or your child may get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
What if I have a preexisting condition?
Starting in 2014, being sick won’t keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition. You can apply for Marketplace insurance when open enrollment starts on October 1st, and coverage starts as soon as January 1, 2014.
I’m young and healthy. Can I buy a ‘catastrophic’ plan?
Yes; people under 30 and some people with limited incomes may buy a “catastrophic” health plan. A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. Costs for essential health benefits over that are generally paid by the insurance company. These policies usually have lower premiums than a comprehensive plan, but cover you only if you need a lot of care. In the Marketplace, catastrophic policies cover three primary care visits per year at no cost, and also cover free preventive benefits. If you have a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or on out-of-pocket costs. When you fill out a Marketplace application, you’ll see catastrophic plans listed as options if you qualify for them.
How do I apply for coverage and enroll in a health plan through the Marketplace?
Starting October 1, 2013, you will be able to file a Marketplace application online (HealthCare.gov), by phone (1-800-318-2596), by mail, or in person (with accommodations for people with disabilities). Coverage starts as soon as January 1, 2014. The Marketplace will automatically tell you if you qualify for discounts or qualify to participate in state programs based on your income. Then you can choose the health plan that’s right for you through the online plan comparison tool.
How do I use healthcare.gov to apply for Marketplace coverage?
You can enroll in health coverage in just four steps using HealthCare.gov.
- Set up an account. You’ll provide some basic information to get started, like your name, address, and e-mail address.
- Fill out the online application. You’ll provide information about you and your family, like household income, household size, current health coverage information, and more. This will help the Marketplace find options that meet your needs.
- Compare your options. You’ll be able to see all the options you qualify for, including private insurance plans and free and low-cost coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace will tell youwhether you qualify for lower costs on your monthly premiums and out-of-pocket costs on deductibles, copayments, and coinsurance. You’ll see details on costs and benefits before you choose a plan.
- Enroll. After you choose a plan, you can enroll online and decide how you pay your premiums to your insurance company. If you or a member of your family qualifies for Medicaid or CHIP, a representative will contact you to enroll.
How is the health care law going to affect those students who have already purchased university sponsored health insurance? If all the requirements are met, can they still get some subsidy from the federal government?
Generally, students who have University-sponsored health insurance will have what is considered minimum essential coverage and will not be liable for the individual shared responsibility provision. They can, however, generally opt out of that coverage, go into the Marketplace and then qualify for a tax credit or Medicaid (depending on their income).
What happens after the deadline for students, such as graduating seniors, who want to enroll?
Losing insurance from another source (like job-based insurance or student health insurance) will trigger a special enrollment period for the Marketplace in which students can apply for coverage.
Are graduate student dependents eligible for Marketplace coverage?