What is the “Marketplace”?
The Marketplace, a breakdown. . .
The Federally Facilitated Marketplace is a centralized platform where individuals, families, and small businesses can compare and purchase health insurance plans. These plans meet specific standards for benefits, consumer protections, and costs.
Marketplace plans are divided into four categories: Bronze, Silver, Gold, and Platinum. These categories reflect the percentage of healthcare costs covered by the plan, with Bronze covering the least and Platinum covering the most. Generally, as you move from Bronze to Platinum, premiums increase while out-of-pocket costs decrease.
Who is eligible for marketplace coverage?
Anyone purchasing health insurance independently can enroll through the Marketplace. However, financial assistance is only available to those meeting specific income criteria who don’t qualify for affordable employer-based coverage or other government programs.
How does the subsidy and tax credit work?
U.S. citizens and lawfully present immigrants with qualifying household incomes may be eligible for subsidies to help pay for premiums. These include:
Premium Tax Credits: Lower monthly premium costs based on income and family size.
Cost-Sharing Reductions: Decrease out-of-pocket costs like deductibles and co-pays for eligible individuals.
Visit the Marketplace website to determine your eligibility for financial assistance.
The 10 Minimum Essentials Marketplace plans will cover
What Benefits Are Covered by Marketplace Plans?
All Marketplace plans cover a set of essential health benefits, including:
Doctor visits
Emergency and hospital care
Pregnancy and newborn care
Mental health and substance use services
Prescription drugs
Rehabilitative services
Laboratory tests
Preventive care
Chronic disease management
Pediatric services (including dental and vision care)
When selecting a plan, check if it covers necessary medications, treatments, and providers, and evaluate all costs, including deductibles and co-pays.
Can I Be Denied Coverage Because of a Pre-Existing Condition?
No. Under current laws, health insurance companies cannot deny coverage or charge higher premiums based on pre-existing conditions like diabetes. This applies to all major-medical plans sold within or outside the Marketplace.
Additionally, plans must cap out-of-pocket expenses and provide preventive services at no extra cost. While plans cannot set dollar limits on essential health benefits, they may impose other limits, such as the number of covered doctor visits or hospital days.
Do I Have to Have Health Insurance?
No, you don’t have to. Since 2014, most individuals are required to have health insurance. Marketplace plans, employer-provided insurance, Medicare, Medicaid, CHIP, TRICARE, and VA health programs all meet this requirement. Although, the federal government stopped imposing tax penalties for not having health insurance in 2019.
What Insurance Providers Offer Plans On The Marketplace?
There are a plethora of different providers available on the marketplace. The options you have to choose from depends on the state you live in. Some examples are: Aetna, Cigna, BlueCross BlueShield, Anthem, Ambetter, Oscar, Molina, Wellpoint, Health First, Christus, AmeriHealth and Baylor Scott & White. To see what options are available in your state, click the link below.
