Health Insurance Marketplace


What is Health Insurance Marketplace ?


Health insurance markets, also known as health exchanges, are organizations in each state in the US that allow peoples to purchase health insurance. The Marketplace was created by the Affordable Care Act (ACA) to provide millions of Americans without health insurance with access to coverage. While many states have their own marketplaces, the federal government manages an exchange that is accessible to citizens of other states.

Individuals, families, and small businesses can purchase insurance policies through the Health Insurance Marketplace. You can purchase insurance through the Marketplace if your employer doesn't provide it, you're self-employed, or you wish to buy your own insurance. For you and your family, the Health Insurance Marketplace provides health, vision, and dental insurance.

You can check your eligibility for Medicaid, the Children's Health Insurance Program (CHIP), free or low-cost coverage, or savings on Marketplace plans with just one application. The majority of applicants will be eligible for some kind of savings.

Key Facts of Health Insurance Marketplace


  • A government operated marketplace where you can compare and buy health insurance is the health insurance marketplace.
  • Those who lack access to health insurance through employer sponsored plans can use the Marketplace.
  • Access to health insurance is made possible via the Health Insurance Marketplace for individuals, families, and small businesses.
  • You can only enroll for a marketplace health plan during open enrollment, with a few exceptions.
  • The market divides health insurance plans into four different metal tiers according on your cost-share.
  • Through the Marketplace, different insurers can compete for clients by providing a range of plans that are based on cost and need.

How the Health Insurance Marketplace Works ?


People who do not have access to employer-sponsored insurance can locate a suitable plan through the Marketplace, which promotes competition among private insurers in one convenient location. During the open enrollment period, people can use the Marketplace to compare plans and submit applications.

This time period usually occurs in November and December of the year before the year the coverage will begin to apply. In the event of a qualified event, such as the birth of a child, marriage, or the termination of another insurance plan, consumers may request for a special enrollment period.

In the order of least to greatest coverage, the Marketplace divides plans into four tiers, bronze, silver, gold, and platinum. The most expensive category, known as platinum, offers plans that cover about 90% of medical costs.

You can access the federal insurance exchange at Healthcare.gov. Instead, some states run their own exchanges. You can utilize the marketplace to purchase coverage as well as to find out if you are eligible for premium tax credits and government health programs like the Children's Health Insurance Program (CHIP) and Medicaid.

All marketplace health insurance plans provide the same fundamental advantages, such as coverage for doctor visits, hospitalization, and prescription medication. Some plans may also provide a few more benefits, like adult dental and vision care. The marketplace allows you to sort plans by many features, including advantages, price, and star rating, to assist you in making the best option possible.

Who is Eligible to use Health Insurance Marketplace?


In order to enroll for health insurance through the Marketplace, you must:

You cannot purchase a health or dental plan through the Marketplace if you have Medicare coverage.

You can utilize the Marketplace regardless of the state where you reside. Several states run their own markets. The Marketplace is managed by the federal government in other states.

What is the Income Limit to Qualify for Marketplace ?


Under Health Insurance Marketplace (Obamacare), anybody can get health insurance, but individuals whose household incomes are between 100% and 400% of the federal poverty level (FPL) may be eligible for financial assistance that lowers premiums and out-of-pocket expenses.

According to federal poverty criteria for 2022, a family of four would be eligible for aid with a household income between $27,750 and $111,000 per year. If a single person made between $13,590 and $54,360, they would be eligible for subsidies. (Alaska and Hawaii have higher federal poverty levels.)

Qualifying Health Coverage


Any health care plan that satisfies ACA standards qualifies as qualifying health coverage, and this can include :

The Affordable Care Act (ACA) mandates that all insurance plans offered by insurers on the Marketplace must meet 10 fundamental criteria, or essential health benefits (EHBs). Benefits that are required include :
  • Hospitalization
  • Prescription medications
  • Ambulatory patient services
  • Laboratory services
  • Emergency services
  • Pediatric services
  • Maternity, pregnancy and newborn care
  • Mental health and substance use disorder services
  • Rehabilitative and habilitative services
  • Preventive and wellness services

Types of Health Insurance Marketplace Plans


Platinum, gold, silver, and bronze level plans are available on the Marketplace. These metal levels show what portion of the expense of health care you and your insurer are responsible for covering.

Category

What You Pay

What the Insurer Pays

Platinum

10%

90%

Gold

20%

80%

Silver

30%

70%

Bronze

40%

60%

The highest percentage of your medical expenses must be covered by bronze coverage, which has the lowest premium. Platinum plans offer the highest premiums but cover the highest costs as a percentage. Usually, less expensive plans have greater deductibles as well.

Several of the most popular kinds of health insurance plans are available on the marketplace :

1) Exclusive Provider Organization (EPO) : 
EPOs require you to seek physicians, hospitals, and specialists within a predetermined network, with the exception of emergency treatment.

2) Point of Service (POS) : 
With a POS, you pay less for medical services offered by in-network doctors, but you need a recommendation from your general care physician to see a specialist.

3) Health Maintenance Organization (HMO) :
HMOs pay for medical services rendered by both doctors they employ and those they have service agreements with. Some HMOs only provide coverage to those who reside or work in a designated service area, and they often only pay out-of-pocket expenses for emergency care.

4) Preferred Provider Organization (PPO) :
PPOs provide discounts when you use the network for medical treatment, and they cover out-of-network care without a prescription for an additional fee.

When to Enroll Marketplace Insurance in 2023 ?


Depending on your situation, you can enroll in a new marketplace plan. Typically, the only time you may enroll for Marketplace insurance is during the fall open enrollment period for the Health Insurance Marketplace.

To apply for new health insurance or to change your health plan for 2023, you have until January 15, 2023. If you enroll by December 15, 2022, your coverage will start January 1, 2023. 

If you need health coverage through health insurance marketplace for 2023, here are some important dates to mark on your calendar :
  • Open Enrollment starts, November 1.
  • Enroll by December 15, 2022 for coverage that starts January 1, 2023.
  • Open Enrollment ends, January 15, 2023.

If you qualify, you can also apply for Medicaid or the Children's Health Insurance Program (CHIP) at any time. Coverage can start immediately.

Special Enrollment Period


You can be eligible for a special enrollment period if you go through specific life events, including as getting married, having a kid, adopting a child, or losing your health insurance. For eligible enrollees, a special enrollment period is always available.

Depending on the qualifying event, you may need to enroll no later than 60 days prior to the qualifying event or no later than 60 days after it in order to be eligible for marketplace special enrollment. For instance, you would be eligible for a special enrollment period that would extend for 60 days after the event if you got married, had a kid, or got divorced.

How to Apply for Health Insurance Marketplace ?


The only time you can enroll in a Marketplace plan is during the Open Enrollment Period. Medicaid or CHIP enrollment is open at all anytime. 

You can apply for a Marketplace plan during the Open Enrollment Period online, over the phone, by paper application, or with the help of a trained assister in your community. Visit the How to Apply & Enroll page to learn more about applying.

How to Get Health Insurance Marketplace Coverage Online ?


You can review and purchase a health plan through health insurance marketplace online at HealthCare.gov. Online applications are typically quicker and simpler. Here is how to start a new application or update an existing one online :
  • Create an account to get started if this is your first time applying for insurance through the Marketplace.
  • Log in, if you already have account to start or update an application.
  • Then enroll by following these 4 steps.

The following list of states and the District of Columbia that operate their own health insurance exchanges. While residents in other states can look for and buy coverage at the federal Health Insurance Marketplace, shoppers in certain places must visit their authorized exchange.

Marketplace Coverage Options 2023


For Marketplace coverage beginning January 1, 2023, take action before December 15. Look over the options and get a idea of your potential costs before enrolling or renewing your coverage.

Ways to save on Marketplace plan on 2023 :
  1. Your state
  2. The number of people in your household
  3. Your estimated household annual income (for help use this calculator)

Contact Health Insurance Marketplace


For more information, visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users should call at 1-855-889-4325. For further information, Find Local Help.

Frequently Asked Questions


What is Affordable Care Act ?
Affordable insurance marketplaces are required by the Patient Protection and Affordable Care Act (ACA), also referred to as Obamacare. The purpose of the clause is to develop a market where people and small business owners can shop around for health insurance plans that adhere to the ACA's requirements for both cost and quality. The ACA requirements for employer-based health insurance must be met. You can still acquire health insurance through the marketplace even if you have a job-based plan. You will need to cover the full cost of a marketplace plan, even if your employer's health insurance program complies with ACA requirements.

Who can get health coverage through the Health Insurance Marketplace?
You must reside in the United States, be a citizen or national (or be legally present), not be incarcerated, and be eligible to enroll in Marketplace health coverage.

When does health insurance marketplace open?
The health insurance exchange is always accessible, but you might not be able to sign up for new coverage. Most people can only enroll in coverage during the open enrollment period (November 1 through January 15), although under some circumstances, you may be able to do so (such as when you get married or have a baby).

How may health insurance that you purchased through the marketplace be cancelled?
The precise cancellation procedure will depend on how and when you intend to terminate your insurance. Learn precisely how to terminate coverage using this page.

What are the benefits of Health Insurance Marketplace?
You may get health insurance that meets your requirements and your budget through the Health Insurance Marketplace. The same core health services, such as doctor visits, preventative care, hospitalization, prescriptions, and more, are included in every health plan available in the Marketplace. Before making a decision, you can evaluate plans based on their costs, advantages, quality, and other aspects that are relevant to you.

When is Open Enrollment for health insurance in 2023 ?
To be covered beginning January 1, take action by December 15th. For coverage that begins January 1, 2023, there is less than a month time to sign up for or make changes to your health insurance through the Marketplace.
  • Open Enrollment started : November 1, 2022
  • Deadline for coverage that starts January 1, 2023 : December 15, 2022
  • Last day to sign up for 2023 coverage : January 15, 2023
Coverage starts on February 1, 2023. You can only purchase a health plan after January 15, if you qualify for a Special Enrollment Period.