What is the Health Insurance Marketplace?

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The Health Insurance Marketplace / ACA is a service available so people can shop and enroll in affordable health insurance. The federal government runs the HealthCare.gov Marketplace, which serves the majority of states.

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You can shop the Marketplace a number of ways. 

You can shop and enroll right here from the safety and security of you own home. We partner to the federal government to allows people to compare, shop, and enroll online in an easy, streamlined manner to help field questions about your health insurance. 

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No matter how you shop the Marketplace, you will provide some basic information about your income and household. Then, you will find out if you qualify for any premium tax credits and any other health insurance savings. You’ll also find out if you or any of your dependents qualify for Medicaid or the Children’s Health Insurance Program (CHIP). 

 

In 2020,  87% of the 10.7 million people who purchased health insurance on the Marketplace received ACA premium subsidies, the Centers for Medicare & Medicaid (CMS) reported. 

To qualify for Obamacare subsidies you must meet the following criteria: 

• You are currently living in the United States

• You are a US citizen or legal resident

• You are not currently incarcerated

• Your income is no more than 500% in 2021 and 2022) of the FPL

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What kind of insurance plans are offered through the Marketplace?

Marketplace health insurance plans have different metal levels: Bronze, Silver, Gold, and Platinum. Generally, Bronze plans have the lowest monthly premiums but also the highest out-of-pocket costs. This trend continues up the line to Platinum plans, which typically have the highest monthly premiums and the lowest out-of-pocket costs.

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All four plans are eligible for premium tax credits, which can help you pay for your health insurance if you meet the income-based qualifications. Silver plans are also eligible for cost-sharing reductions, a subsidy that lowers the amount you have to pay for deductibles, copayments, and coinsurance. Cost-sharing reductions are also known as cost-sharing subsidies in Marketplace health insurance plans. No matter what it’s called, these are extra savings on your ACA / Obamacare plan.

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There is also another type of plan available: Catastrophic. These have even lower monthly premiums than Bronze plans, but they also have very high out-of-pocket costs. These plans cover essential health benefits and are only available to people under 30, unless you’ve obtained a hardship exemption. Catastrophic plans are not eligible for the premium tax credit, however, so depending on your income, a Bronze plan may end up being more affordable after applying a tax credit.

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What type of health services are covered by Marketplace plans?

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Thanks to the Affordable Care Act, all health plans offered on HealthCare.gov cover the following essential health benefits:

• Ambulatory patient services (outpatient care without admittance to a hospital)

• Emergency services

• Hospitalization (like surgery and overnight stays)

• Pregnancy, maternity, and newborn care (both before and after birth)

• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

• Prescription drugs

• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

• Laboratory services

• Preventive and wellness services and chronic disease management

• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

• Birth control coverage

• Breastfeeding coverage

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Who can enroll in a Marketplace plan?

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The Affordable Care Act ensure that almost all Americans can buy individual and family health insurance from the online Marketplace. 

To qualify to shop on the Marketplace, there are just a few general requirements. You need to live in the U.S., not be incarcerated, and be a U.S. citizen. You can also shop the Marketplace if you hold a permitted immigration status, like being a refugee or green card holder. 

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When can I enroll in a Marketplace plan?

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If you meet these general criteria, you can shop for Obamacare plans during the annual Open Enrollment Period (OEP). Each year, there is an Open Enrollment Period when almost all Americans can buy health insurance under the Affordable Care Act. The dates of the Open Enrollment Period change every year, and last for six weeks in most states. Almost everyone who enrolls during OEP will have insurance coverage beginning on January 1st of the upcoming calendar year. 

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You can also shop on the Marketplace during a Special Enrollment Period (SEP) if you have a qualifying life event like getting married or welcoming a new child into your family. Here are three general categories of qualifying life events that can trigger a Special Enrollment Period: Loss of health coverage, changes in your household, and changes in residence. There is no such thing as a pre-set Special Enrollment Period in the United States. Rather, a Special Enrollment Period begins when a person has a qualifying event.

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Can I get a subsidy for health insurance?

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Depending on your income level, you might be able to qualify for some kind of subsidy or savings for your health insurance.

If you live in a state with expanded Medicaid coverage and you earn 138% or less of the federal poverty level, you may qualify for Medicaid. Both Medicaid and CHIP (Children’s Health Insurance Program) are forms of subsidized health insurance. 

In all states, however, if your income falls between 100% and 400% of the federal poverty level, you can qualify for a premium tax credit that can lower the amount you pay in monthly premiums. Again, the process of applying for Marketplace insurance will automatically notify you of any tax credits, sometimes called subsidies, for which you might qualify. 

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Affordable coverage

In 2023, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.12% of your household income.

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• The lowest-cost plan must also meet the minimum value standard.

• If you’re the employee, affordability is based on only the premium you’d pay for self-only (individual) coverage.

• For coverage starting January 1, 2023, if you’re offered job-based coverage through a household member’s job, affordability is based on the premium amount to cover everyone in the household.

• Total household income includes incomes from everybody in the household who’s required to file a tax return.

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If the premiums aren’t considered affordable for the employee and the household, they may qualify for savings in a Marketplace plan. But, if the premium is considered affordable for the employee, but not for other members of the household, then only the other household members may qualify for savings.

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Example:

• Household’s monthly income = $4,083 (about $49,000 per year).

• 9.12% of the household’s monthly household income = $372

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For the employee:

• Monthly premium the employee would have to pay for the lowest-priced plan that covers just the employee = $300

• Is the plan affordable for the employee? YES. The premium the employee would have to pay to cover just themselves ($300) is less than 9.12% of the household’s income ($372). Because the job-based coverage is affordable for the employee, the employee won’t qualify for savings in the Marketplace.

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For other household members:

• Monthly premium the employee would have to pay for the lowest-priced plan that covers other members of their household = $450

• Is the plan affordable for other household members? NO. The premium the employee would have to pay to cover others in the household ($450) is more than 9.12% of the household’s income ($372). Because the job-based coverage isn't affordable for the employee’s household members, the employee’s household members may qualify for savings in the Marketplace.

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To learn more about this and other Health related topics, talk with a professional in your community. Make an appointment to speak with one of our professionals and see for yourself the Elkin Insurance difference. At Elkin Insurance "We Care About You".

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Call: 336-366-0960

Text: 336-366-0960

Email: Info@Elkininsurance.com