A One-Page Guide To The Health Insurance Marketplace

Here’s a quick rundown on the most important things to know about the Health Insurance Marketplace, sometimes known as the health insurance “exchange.”

Currently, and before November 15, 2014, you can enroll in a Marketplace health plan only if you qualify for a Special Enrollment Period. Any plan that you enroll in before November 15, 2014 ends December 31, 2014. You can apply for Medicaid and CHIP any time. Find out if you qualify for a Special Enrollment Period or view plans and prices for coverage ending December 31, 2014.

The Health Insurance Marketplace helps uninsured people enroll in health coverage, and offers:

• Private health insurance with savings based on your income. Plans cover essential health benefits, pre-existing conditions, and preventive care. Most people who apply through the Marketplace qualify for premium tax credits and savings on out-of-pocket costs based on household size and income.

Plans and estimated prices for 2015 coverage will be available in early November. In the meantime, learn how to compare plans and choose one that’s right for you.

• Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide free or low-cost coverage to millions of families with limited income. Many states are expanding Medicaid to cover more people. Find out what Medicaid expansion means for you.

Fees, exemptions, and qualifying coverage

• Most people must have health coverage or pay a fee. If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child) — whichever is higher.
• You’re considered covered under the health care law if you have an employer-sponored plan, a plan you bought yourself, Medicare, Medicaid, CHIP, and many other kinds of coverage. See a full list of plans and programs that meet the health law’s coverage requirement.
• Some people qualify for an exemption from the penalty based on income or other situations.

Three more things to note:

• If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you’ll qualify for premium tax credits and other savings based on your income only if the job-based insurance isn't considered affordable or doesn’t meet minimum value requirements.
• If you have Medicare, you’re considered covered and don’t have to make any changes. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan.
• You can buy a plan outside the Marketplace and still meet the health care law’s coverage requirements. But if you buy outside the Marketplace, you won’t be eligible for premium tax credits or other savings based on your income.

Give us a call today!  We will walk you through the Marketplace, and help you find the plan that's right for you, and your budget.