Health exchanges are commonly known as Marketplaces. Under the Affordable Care Act, each state has its own Marketplace. They are price comparison websites for subsidized health insurance. In here you can find coverage according to your needs and budget.
The exchanges are great for comparing plans side by side, finding out if you can get lower costs, and learning more about the new rights, benefits and protections.
Whether you are uninsured or you are not satisfied with your current insurance, the Marketplace offers you tools to make well-informed decisions.
You can get a quote first or dive right into the application process.
If you want to get a quote, the Marketplace lets you preview plans and prices available in your area. They reflect any lower costs based on your income and household size.
If you want to start the enrolling process, you can do it right away. It is easy and fast.
Health insurance plans in the Marketplace are available in five categories:
- Platinum - have the highest premiums but the lowest co-pays and deductibles.
- Gold & Silver - have lower premiums but higher co-pays and deductibles.
- Bronze - have the lowest premiums but the highest co-pays and deductibles.
- Catastrophic (Available Plans for People under 30) - These plans usually have high deductibles, essential benefits and they are more Affordable.
Each health plan may have different doctors, hospitals, or providers in its networks. You can look up doctors, hospitals or providers online at your Marketplace.
All plans offered in the Marketplaces are certified as qualified health plans, or QHPs. These QHPs are licensed and accredited, and they meet certain requirements for transparency.
- Coverage, at a minimum, of a comprehensive package of benefits, known as essential health benefits, or EHB.
- Benefit design standards, including non-discrimination requirements and limits on cost-sharing and out-of-pocket costs.
- Network adequacy standards.
If you have trouble with your premium you may be eligible for an Advanced Tax Credit, Cost Sharing, Medicaid or CHIP. You have options in the Marketplace.
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 can get considerably less cost assistance.
Subsidies are given as refundable tax credits.
If you are already insured, you can still check your options at your Marketplace.
The national health care reform offers individuals, families, and small businesses new options, enhanced benefits, and savings.
Some major reforms include:
- An end to discrimination for pre-existing conditions. Insurers can no longer deny coverage or charge more because of a pre-existing condition.
- Coverage for preventive services with no deductible or co-pay.
- The removal of lifetime limits on health benefits.
- New coverage options for young adults. If your plan covers children, you can keep them in your health insurance policy until they are 26 years old.
- Prescription drugs affordable for seniors.
- And more…
The Health Insurance Marketplace also offers a comprehensive package of items and services, known as essential health benefits.
Essential health benefits must include items and services within at least the following 10 categories:
- ambulatory patient services;
- emergency services; hospitalization;
- maternity and newborn care;
- mental health and substance use disorder services, including behavioral health treatment;
- prescription drugs;
- rehabilitative and habilitative services and devices;
- laboratory services;
- preventive and wellness services and chronic disease management; and
- pediatric services, including oral and vision care.
If you didn’t know, Exchanges also offer dental plans. The Marketplace works as a one-stop-shop offering health and dental coverage.
You can get dental coverage as part of a health plan or by itself through a separate, stand-alone dental plan. If you choose a separate dental plan, you’ll pay a separate, additional premium for the dental plan.
Under ObamaCare, Dental coverage for children is an essential health benefit, which means it must be available to you as part of a health plan or as a free-standing plan.
Insurers don’t have to offer adult dental coverage though.
Keep in mind you do not need to have dental coverage to avoid the penalty.
Whatever you do, there is help along the way. You can get help online, over the phone or even in person.
- Online: HealthCare.gov
- Phone: Individuals & Families – 1-800-318-2596, TTY: 1-855-889-4325 and Small Businesses – 1-800-706-7893, TTY: 1-800-706-7915.
To access your Marketplace visit here