Are you, like many Americans, having difficulties finding the right health insurance plan for yourself and your family?
From looking through the offers by different providers, to obtaining coverage details and quotes, to working out the estimated costs, you can easily be overwhelmed by all the terms and options that are available to you. The truth is, the entire decision-making process can be complicated and lengthy. At some point, you may even find yourself having to make decisions within a very limited time frame, making the already frustrating process even more challenging.
The Health Insurance Marketplace is the platform set up by the Federal government to help you access the information you need to make informed decisions on your healthcare coverage. You can also enroll in the plans through the platform. To ensure a seamless process, contact agents such as EASY Insurance Plans to walk you through the entire process.
What Is the Health Insurance Marketplace?
The Federal Health Insurance Marketplace (also known as the "Marketplace" or "Exchange") is a website where American individuals, families, and small businesses can shop and enroll in health insurance plans.
The Marketplace is a convenient one-stop-shop platform for insurance plan shoppers. Through online or in-person approach, you will be able to:
- Browse and compare insurance plans and prices
- Choose the benefits and plan that best suits your individual needs
- Find the most affordable benefits package
- Get answers to questions about your health care insurance
- Find out your eligibility for tax credits
- Enroll in a health insurance plan that meets your needs
The Marketplace was created as part of the Affordable Care Act (ACA) in 2010 (commonly known as "Obamacare") so that all U.S. consumers could afford quality healthcare coverage regardless of their income or pre-existing conditions.
Who Is Eligible For Health Insurance Marketplace?
To be eligible to enroll in Health Insurance Marketplace, you must live in the U.S., be a U.S. citizen or national (or be lawfully present), and not be incarcerated.
Your household income level will determine whether and how much premium subsidy you are entitled to. Check out this link for more details.
If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.
The purpose of the Marketplace is to provide subsidies to uninsured populations with a place to purchase health insurance. Uninsured populations include:
- People who lost their jobs and access to health coverage
- Workers whose employers do not offer health insurance as a benefit option
- People who are self-employed, freelancers, or early retirees who are not yet eligible for Medicare.
Things You Need To Know Before Picking A Marketplace Plan
Choosing a health insurance plan for yourself and your family can be a complicated process.
Knowing the following information before you start comparing plans can make the process easier:
1. The 5 categories of health insurance plans
Bronze, Silver, Gold, Platinum and Catastrophic. These categories show how you and your plan share costs. The categories have nothing to do with the quality of care.
2. Your Total Costs For Health Care
It is important to understand the kind of costs you need to pay. You pay a monthly fee to your insurance company (a "premium") even if you don’t use medical services that month. When you get healthcare services, you pay out-of-pocket costs, including a deductible.
3. Plans and Network Types (HMO, PPQ, POS, EPO)
You will see terms like HMO, PPQ, POA, EPO. Each represents the network types of your health care plan. Some plan types allow you to use almost any doctor or healthcare facility. Others limit your choices or charge you more if you use providers outside their network. Check out the definition of each type of health care plan before deciding which plan fits you best.
What Plans Does The Marketplace Offer?
The available plans in the Marketplace are offered in 4 categories - Bronze, Silver, Gold, and Platinum. "Catastrophic Plans" are also available to some people.
Again, the plan categories are classified based on how you and the insurance company split the cost. They have nothing to do with the quality of the benefit you receive. All plans provide free preventive care.
Bronze (Insurance pays 60%, You pay 40%)
- Lowest monthly premiums
- Highest out-of-pocket costs
- Higher deductible
- More for those who are looking for affordable health coverage.
- Good choice if you are looking for low-cost coverage to protect you from serious sickness or injury.
- If you do not need to visit a doctor on a regular basis, you may benefit from this plan as you would save money on lower premiums over time but you will have to pay for most routine care yourself.
Silver (Insurance pays 70%, You pay 30%)
- Moderate monthly premiums
- Moderate out-of-pocket costs
- Lower deductible than those in the Bronze plan
- Get extra savings with a silver plan. If you are qualified for Cost-Sharing Reductions (CSR), you must select a silver plan to get your discount savings. If you’re enrolled in a silver plan and lose your cost-sharing reductions, you’ll qualify for a Special Enrollment Period. If you want to change plans, you can enroll in a Bronze, Silver or Gold plan according to your budget.
- Good for those who qualify for the extra savings options.
- If you are willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
- If you need frequent medical care per year, the extra saving can go up to a few hundred or even thousands of dollars per year.
Gold (Insurance pays 80%, You pay 20%)
- Higher monthly premium
- Lower out-of-pocket costs
- Lower deductible
- Recommendation: If you are willing to pay more each month to have more costs covered when you get medical treatment. You would benefit from Gold if you need medical attention regularly.
Platinum (Insurance pays 90%, You pay 10%)
- Highest monthly premium
- Lowest out-of-pocket costs
- Lowest deductible
- If you need a lot of medical care per year.
- You can afford higher monthly premiums in exchange for lower out-of-pocket costs.
- Very low monthly premiums
- Very high deductible
- Recommendation: An affordable way to protect yourself from serious sicknesses or injuries. But you pay most routine medical expenses yourself.
In order to qualify for catastrophic plans, you have to be either:
- aged under 30
- over 30 years old and eligible for hardship or affordability exemption are eligible for a catastrophic plan.
Catastrophic plans cover the same health benefits as other Marketplace plans with all preventive services covered at no cost. However, this option is excluded from the premium tax credit and you may consider if it is the best financial option for you.
Save Money On Health Insurance Premium
No matter which health plan category you choose, you can save a lot of money on your monthly premium based on your income.
When you fill out a Marketplace insurance application, you will find out if you qualify for a Marketplace plan with a lower monthly premium plus extra savings, including lower deductibles and copayments. You may also be eligible for the premium tax credits.
You can do a quick check here to see if your income is within the range to qualify.
Health Insurance Marketplace Requirements
Health benefits may vary based on each state's requirements on Marketplace. However, all Marketplace plans must cover the below 10 essential health benefits as minimum requirements:
10 essential health benefits
- Ambulatory patient services
- Emergency services
- Laboratory services
- Prescription drugs
- Preventive and wellness services and chronic disease management
- Rehabilitative and habilitative services and devices
- Mental health and substance use disorder services, such as behavioral health counseling
- Pregnancy, maternity, and newborn care
- Pediatric services, including oral and vision care
Plans may also include the follows benefits:
- Birth control coverage
- Breastfeeding coverage, such as lactation specialists, counseling, and equipment
Specific services and benefits may be covered by some states, which may include:
- Dental coverage
- Vision coverage
- Medical management programs (for specific needs like weight management, back pain, and diabetes)
How to Choose a Plan From the Health Insurance Marketplace
Below are some of the factors to consider before deciding which insurance plan is the best for you and your family:
- Frequency of healthcare you need
- Your health condition based on your history
- Any planned healthcare needs, such as surgical procedures scheduled, regular monitoring of certain medical conditions
- Your budget, long-term finances and affordability
Gold or Platinum might be the best options if you predict you will need frequent doctor’s visits, hospital stays, or medical procedures.
On the other hand, Bronze or Silver might suit you better if you have minimal healthcare needs. You can save on the monthly premiums since you seldom need health care services.
There should also consider carefully your budget and financial strength. You need to strike a balance between how much coverage you need and what fits within your budget.
When Can You Enroll In Health Insurance Marketplace?
The next open enrollment period will be from November 2023 until January 2024. If you are currently having Marketplace coverage, you will need to renew your enrollment during the open enrollment period.
You can enroll in a plan during the open enrollment period each fall (around Nov) for coverage the following year.
If you wish to enroll in or make changes to your health plan outside the open enrollment period, you need to qualify for a Special Enrollment Period which has to be triggered by a qualifying life event (QLE).
A life event is generally a significant change that occurs in your life. Such as a change to your family, your residence, your previous health coverage, loss of employer-provided coverage, and other reasons. Note that you usually have 60 days from that event to enroll.
How To Apply For 2024 Health Insurance Marketplace?
Having read all the basic information about Marketplace we listed above, it's now time to decide on the right plan for you and your family.
Don't know where and how to start? Don't worry, as we mentioned, our team of licensed agents at EASY Insurance Plans will walk you through the entire sign-up process. We will break down and compare the offers from different providers and their plans, and answer whatever questions you have, such as the deductibles and copayment of each plans.
We are here to help you find the plan that best suit your needs.
What Other Government Healthcare Benefits Are There?
While the ACA and the Marketplace have helped bring affordable healthcare coverage to many who were uninsured, there are other options out there when it comes to public medical assistance program.
When you approach the age of 65, you will be eligible for Medicare, which is another national health care program offered by the U.S. government. Medicare is also available to people with certain types of disabilities or medical conditions.
There are many different insurance companies, agents and brokers offering Medicare policies.
If you are looking for an experienced Medicare agent that has your best interest in mind, EASY Insurance Plans will be happy to take the time and discuss your Medicare options.
Not turning 65 but looking for an independent agent to help determine what the best coverage health plans are available for you and your family?
We can compare your current health insurance coverage with other plans in your area to help you find the best fit.