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What is a Health Insurance Marketplace and Who Should Care

What is a health insurance marketplace?

Also known as health insurance exchanges, a health insurance marketplace is part of the Affordable Care Act (ACA), better known as healthcare reform.

The marketplace is an online store where people can shop for health insurance, compare the various plans, and enroll in a plan.

Starting January 1, 2014, people who do not have health insurance must either enroll in a health insurance plan or pay a fee.

The Fee, or tax penalty, will increase each year the individual does not enroll in a health insurance plan. The fee starts in 2014 at 1% of annual income or $95 per adult ($47.50 per child), whichever is higher. That penalty will be paid on your 2014 tax return, due April 2015.

When you apply for coverage in the marketplace, you’ll find out if you qualify for financial assistance, including a premium tax credit.

Federal or State Marketplaces

Many states will operate their own health insurance marketplace.

If your state chose not to develop a health insurance marketplace, you will use the federal government’s health insurance exchanges.

In either case, visit, healthcare.gov, to find out if your state operates a health insurance exchange or to utilize the federal government’s health insurance exchange.

The marketplaces will allow you to shop for health insurance plans under four separate categories: bronze, silver, gold and platinum, each presenting different levels of coverage and costs.

10 Essential Health Benefits

No matter which health plan you purchase through the exchange, it will provide 10 essential health benefits:

  1. Outpatient care—this refers to any care that doesn’t require a hospital stay
  2. Emergency room visits
  3. Inpatient care—any care that requires a hospital stay
  4. Care during pregnancy and after your child is born
  5. Mental health and substance abuse treatments—includes counseling, psychotherapy and behavioral health treatment
  6. Prescription drugs
  7. Treatment related to injuries, disabilities or chronic conditions—this refers to physical therapy, occupational therapy, psychiatric rehabilitation, speech-language pathology/therapy and others.
  8. Laboratory tests
  9. Preventive medical care, which includes vaccines, disease screening and counseling, as well as any care needed to manage chronic diseases
  10. Pediatric care, including dentistry and vision treatment for children

Enrollment Basics

Enrollment opens October 1, 2013. If you enroll by December 15, 2013, your coverage typically will start on January 1, 2014.

Here is a short list of things you can do to prepare:

Is the health insurance marketplace for you?

If you already have insurance through your employer, or are covered by Medicare or purchase insurance privately, you do not need to sign up for health insurance.

However, if you have the option and would like to consider different and/or better coverage, you can utilize the health insurance marketplace.

If you do choose a plan through the marketplace, your employer is not required to contribute to your coverage.

If you do not have insurance, you are required to sign up for coverage.

The Affordable Care Act was designed to provide health insurance coverage at a reasonable price for the millions of Americans who are not covered by insurance.

The health insurance marketplace was set up to make it easy for individuals without insurance to shop, compare and enroll in a health insurance plan that will most adequately meet their needs.

Disclaimer: Much of this information is based upon media sources, such as the AP wire services, newspapers, magazines, books, online news blog and news services, and radio and television, which we deem to be reliable. However, we have undertaken no independent investigation to verify the accuracy of the information reported by these media sources. We therefore disclaim all liability for false or inaccurate information from these media sources. We also disclaim all liability for the third-party information that may be accessed through the material referenced in our emails or posted on our website.