You can find health coverage that meets your needs and budget in the Marketplace. The Marketplace is your State’s price comparison website for subsidized health insurance.
There are plans available for:
- Individuals & Families.
- Small Businesses.
The Marketplace lets you compare what different plans have to offer before you apply. To get a premium estimate visit here
Each state has its own Marketplace. To visit yours and enroll, please click here
Individual Shared Responsibility Fee
ObamaCare’s individual mandate or Individual Shared Responsibility Fee requires that most Americans obtain health insurance by 2014 or pay a tax penalty. The penalty will be applied to your annual taxable income for each month you don’t have health insurance. There is a 3 month grace period hence the marketplaces being open until March 31st, 2014. The fee for not having insurance in 2014 is $95 per adult and $47.50 per child or 1% of your taxable income (up to $285 for a family), whichever is greater.
Employer Shared Responsibility Payment
The Employer Shared Responsibility Payment also commonly referred to as the ObamaCare Employer Mandate was originally set to begin in 2014, but will be delayed until 2015. The mandate requires all businesses with over 50 full-time equivalent (FTE) employees to provide health insurance for their full-time employees, or pay a per month “Employer Shared Responsibility Payment” on their federal tax return.
When you get coverage in the Marketplace, you may be able to get lower costs on monthly premiums depending on your income and family size. You may also get lower costs on deductibles, copayments, and coinsurance.
The Affordable Care Act provides two programs to help individuals afford coverage through the Marketplace:
- Premium tax credits.
- Cost-sharing reductions.
Subsidies are aimed at people with incomes between 139% to 400% of the FPL (federal poverty level).*Current 139% FPL is $23,050 for a family of four and the 400% is $92,200.
Families who make more than the current FPL will get considerably less cost assistance.
Subsidies are given as refundable tax credits.
For more information about this matter, please click here
If you were not able to enroll in an insurance plan by December 23 because you experienced problems using HealthCare.gov, you still may be able to get coverage that starts January 1. You can contact the Marketplace Call Center at 1-800-318-2596 (available 24/7 – TTY: 1-855-889-4325) and representatives will explain your options.
Help and support
To find local help, you can go here or if you have any questions call 1-800-318-2596.
- Why should I get coverage in the Health Insurance Marketplace?
The Marketplace lets you compare plans and prices in your state before you apply.
The Marketplace offers subsidized health insurance to help uninsured people find health coverage.
By filling out the application, the Marketplace will tell you if you qualify for Private health insurance plans, Medicaid or/and the Children’s Health Insurance Program (CHIP).
The Marketplace will also let you know if you qualify for lower costs based on your household size and income.
The plans offered in the new Health Insurance Marketplace cover essential health benefits, pre-existing conditions, and preventive care.
If you don’t qualify for lower costs, you can use the Marketplace to buy insurance at the standard price.
No matter what state you live in, you can use the Marketplace. Some states operate their own Marketplace; others are run by the federal government. Just go to the website and pick your state. Click here
Most people must have health coverage in 2014 or pay a fee. If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). This fee increases every year. Some people may qualify for an exemption to this fee. If you enroll by March 31, 2014, you won’t have to pay the fee for any month before your coverage began.
You’re considered covered and do not need to get insurance from the Marketplace if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.
Remember that if you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. You won’t qualify for lower costs based on your income unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums if you switch to a plan in the Marketplace.
- What does Marketplace health insurance cover?
The Marketplace lets you compare health insurance plans options based on price and benefits. It lets you choose the combination of price and benefits that fits your budget and meets your needs.
- When you sign up for a health insurance plan through the Marketplace you:
You can get lower costs on coverage:
- The Marketplace application will tell you if you’re eligible for lower costs on your monthly premiums or out-of-pocket costs for private insurance or if you are eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
- You have access to a comprehensive set of essential health benefits including doctor visits, preventive care, hospitalization, prescriptions, and more.
- Your pre-existing conditions are covered.
You can get help in your area. Please contact us
Remember that most people are required to have health coverage. If you need coverage, you can use the Marketplace. If you have coverage, you gain new protections. If you don’t have coverage, you may have to pay a fee.
- What information do I need to provide to know if I qualify for lower costs on Marketplace coverage?
You will need to provide income and household information to find out if you qualify for lower costs on Marketplace coverage.
When you fill out the application include:
- Your spouse.
- Your children who live with you, even if they make enough money to file a tax return themselves.
- Your unmarried partner who needs health coverage.
- Anyone you include on your tax return as a dependent, even if they don’t live with you.
- Anyone else under 21 who you take care of and lives with you.
- Your unmarried partner who doesn’t need health coverage and is not your dependent.
- Your unmarried partner’s children, if they are not your dependents.
- Your parents, who live with you, but file their own tax return and are not your dependents.
- Other relatives who file their own tax return and are not your dependents.
If you need information about who qualifies as a dependent, refer to IRS Publication 501
You should also estimate your income for 2014. Your household income is your modified adjusted gross income (MAGI) (joint MAGI if you’re married), plus the MAGI of your dependents who make enough money to have to file a tax return. MAGI is generally your adjusted gross income plus any tax-exempt Social Security benefits (except for Supplemental Security Income (SSI), which is not counted), tax-exempt interest, and tax-exempt foreign income. You don’t have to figure out your household income or MAGI yourself when you fill out your application. It will be done for you with the income information you include on the application.
When filling out the application add up the following:
- You and your spouse, if you are married and will file a joint tax return.
- Any dependents who make enough money to be required to file a tax return.
For each of the following sources, estimate what your income will be in 2014:
- Net income from any self-employment or business.
- Unemployment compensation.
- Social Security payments, including disability payments, but not Supplemental Security Income (SSI).
- Retirement income.
- Investment income.
- Pension income.
- Rental income.
- Any taxable income such as prizes, awards, and gambling winnings.
Don’t include the following:
- Child support.
- Supplemental Security Income (SSI).
- Veterans’ disability payments.
- Workers’ compensation.
- Proceeds from loans.
- What factors affect Marketplace health plan premiums?
There are only 5 things that can affect premium costs. These are:
- Age: Older people can be charged up to 3 times more for premiums than younger people.
- Geographic location: Competition, local regulation, and cost of living in different areas account for this.
- Tobacco Use: Tobacco users can be charged up to 50% more than those who don’t use tobacco.
- Individual vs. family enrollment: Insurers can charge more for a plan that covers a spouse and/or dependents.
- Plan category:
- Plans are available in five categories: Bronze, Silver, Gold, Platinum, and catastrophic.
- The categories reflect how you and the plan share costs.
- Bronze plans will likely have lower premiums and higher out-of-pocket costs.
- Platinum plans are likely to have the highest premiums and lowest out-of-pocket costs.
You should also take into consideration that:
- States may limit how much these factors can affect premiums.
- All Marketplace health plans cover the same list of essential health benefits.
- Insurance companies may offer more benefits than the minimum, which could also affect costs.
- Insurance companies can’t charge women more than men for the same policy.
- Insurers can’t take health status into account when setting rates.
- All Marketplace policies must cover treatment for pre-existing conditions from the first day coverage begins.
- The Marketplace lets you preview health plans and prices in your area.
- Price quotes will reflect any lower costs you may be eligible for based on your income and household size.
- What if I don’t have health coverage in 2014?
Under the Affordable Care Act if someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. This fee is a Tax Penalty also known as “individual responsibility payment,” “individual mandate,” or penalty.
People who are eligible for health insurance, but decide not to have it:
- If you don’t have health insurance and you can afford it you have to pay the penalty.
- You will also have to pay the entire cost of all your medical care.
- You won’t be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.
The penalty in 2014 is calculated one of 2 ways (You’ll pay whichever of these amounts is higher):
- 1% of your yearly household income.
- $95 per person for the year ($47.50 per child under 18).
The fee increases every year. In 2015 it’s 2% of income or $325 per person.
If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured.
If you’re uninsured for less than 3 months, you don’t have to make a payment.
If you enroll by March 31, 2014 you won’t have to make the individual shared responsibility payment.
If you enroll in a health insurance plan through the Marketplace by March 31, 2014, you won’t have to make the payment for any month before your coverage began.
If you pay the penalty, you’re not covered.
After open enrollment ends on March 31, 2014, you won’t be able to get health coverage through the Marketplace until the next annual enrollment period, unless you have a qualifying life event.
Minimum essential coverage:
If you’re covered by any of the following in 2014, you’re considered covered and don’t have to pay a penalty:
- Any Marketplace plan, or any individual insurance plan you already have.
- Any employer plan (including COBRA), with or without “grandfathered” status.
- The Children’s Health Insurance Program (CHIP).
- Veterans health care programs.
- Peace Corps Volunteer plans.
- Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014.
Other plans may also qualify. If you have any questions call 1-800-318-2596, TTY: 1-855-889-4325.
If you have only these types of coverage, you may have to pay the fee. Examples include:
- coverage only for vision care or dental care
- workers’ compensation
- coverage only for a specific disease or condition
- plans that offer only discounts on medical services
Several groups are exempt from the requirement to obtain coverage or pay the penalty.
- People whose health coverage may cost more than 8% of their household income.
- People with incomes too low for filing taxes.
- People with religious exemptions.
- Undocumented immigrants.
- People who are incarcerated.
- Members of Native American tribes.