Understanding the Health Insurance Marketplace

Understanding the Health Insurance Marketplace

More commonly known as Obamacare, the Affordable Care Act (ACA) was signed into law in 2010. The Act made changes to health care law and created an online health care marketplace where people could find, compare and purchase health insurance plans. By 2016, the Act had helped to provide health insurance coverage to an extra 20 million US citizens, cutting the number of uninsured Americans in half. 

The ACA mandated that individuals take out health insurance via the marketplace in order to avoid a tax penalty. Through cost reductions and subsidies, Obamacare was able to provide essential health benefits to American citizens.

For basic marketplace insurance information, here is the Health Insurance Marketplace explained.

What is the Health Insurance Marketplace?

The Health Insurance Marketplace is a website that allows consumers to compare health insurance plans and learn more about the different types of health insurance coverage. It arose out of the ACA as a way for Americans to more easily access the right health insurance plans and to discover what is covered by health insurance. 

As a result, citizens are able to save money on health insurance. As more people became insured, health insurance companies could lower the cost of health insurance plans.

The health care Marketplace allows citizens to:

  • Enroll in the right health insurance plan for their needs.
  • Receive accurate health insurance information.
  • Gain access to information about deductibles, subsidies and tax credits.
  • Compare different health insurance plans to find the most affordable option.

In providing these benefits, the ACA has opened health care up to tens of millions of Americans who were previously uninsured. Although it still depends on a free market system of private health plans, the extra regulations have helped to make care coverage more affordable and accessible.

In some states, extra support is given to low-income people. One ACA provision, “The Medicaid Expansion,” allows states to make their Medicaid eligibility requirements more accessible to adults. Medicaid is a government health care program that provides free or low-cost health insurance to low-income Americans. When applying through the health insurance marketplace, users will find out if they are eligible for Medicaid. 

Open Enrollment Periods

If you want to receive private health insurance coverage through the Health Insurance Marketplace, then it’s essential to apply during open enrollment periods. The limit on open enrollment insurance is designed to encourage more citizens, including younger and healthier people, to take out Obamacare insurance. 

Open enrollment dates may change year to year, but they can easily be found online. In 2020, open enrollment begins on November 1 and runs through to December 15. You must apply between these dates in order to receive ACA-approved health care coverage starting January 1, 2021. 

Remember, this is just the enrollment for the Health Insurance Marketplace. If you want to apply for health insurance and have a low income or other qualifying condition, then you can opt for Medicaid or the Children’s Health Insurance Program (CHIP) at any time. If you still wish to access the health care Marketplace outside of the open enrollment period, however, you may be able to find a health insurance plan via a special enrollment period.

Special Enrollment Periods

A special enrollment period is granted to citizens in some circumstances, allowing them to access Obamacare plans outside of the open enrollment period. Certain life events will make you eligible for special enrollment in a health insurance coverage plan through the Health Insurance Marketplace. However, you will have to apply within 60 days of the life event. Not doing so will likely mean you have to wait until the next open enrollment period to apply for the health care Marketplace.

Life events that give you access to the special enrollment period include:

  • Having a baby.
  • Adopting a child.
  • Moving to a new address.
  • Getting married.
  • Losing your job-based health insurance.

If any of these apply to you, then try to apply for health insurance during your special enrollment period. You may be able to gain access to the ACA Marketplace without waiting for open enrollment. If successful, you can then begin browsing through the different types of Obamacare plans.

Health Plan Categories

The Health Insurance Marketplace divides Obamacare insurance into four categories: bronze, silver, gold and platinum. Despite the names, each category does not offer a different quality of health care services. The quality of care will be the same, regardless of which category you opt for. The main difference between them is regarding how much is covered by you and how much is covered by the insurer.

Bronze

  • Your insurance company will cover 60 percent of the costs, leaving you to pay 40 percent.
  • This category of plans has the lowest premiums you will pay each month.
  • When you do need care coverage, this plan is the most expensive. 
  • Your deductible will be high.
  • This option is perfect for people with no serious health issues who want a low-cost option to cover emergencies.

Silver

  • Your insurance company will cover 70 percent of health care costs, leaving you to pay the remaining percent.
  • This category has mid-range premiums you will pay each month.
  • When you need health care, you will pay a mid-range amount.
  • The deductible is lower than a bronze plan.
  • If you qualify for extra savings on account of your income, then you must use a silver plan to access them.
  • It is an ideal option if you want to take advantage of extra savings or you are just willing to pay more now to save on health costs later on.

Gold

  • Your insurer covers 80 percent of health care costs, while you pay the remaining 20 percent.
  • Monthly premiums are high.
  • Deductibles tend to be low.
  • The cost of health care is low when you need services.
  • This option should be considered by people who are expecting high medical bills and require health care services often.

Platinum

  • The insurance company will pay 90 percent of costs, leaving you with just 10 percent.
  • Of all the plans, this one costs the most for premiums each month.
  • When it comes to receiving health care, it will cost you the least.
  • Deductibles are low.
  • If you require health care a lot and have the money to pay a high monthly premium, this is the best option to give you peace of mind, knowing that almost all of your health care costs will be covered.

How to Apply for Health Insurance on the Marketplace

If you want to apply for the Health Insurance Marketplace, then it’s a relatively simple process and can be done online.

  • Visit the Health Insurance Marketplace during an Open Enrollment Period or a Special Enrollment Period.
  • Fill out the application form, being as accurate as you can.
  • Choose a plan.
  • Wait for your application to be accepted.

That’s it! If your application is successful, you will be covered by an ACA Marketplace plan and will receive coverage.

If you need help, the ACA website has links to certified agents, brokers or assisters who can assist you.