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What is the health insurance marketplace?

Keep in mind...
  • Consumers can access the federal marketplace at healthcare.gov
  • The health insurance marketplace consists of federal and state agencies
  • Sixteen states and the District of Columbia operate healthcare exchanges
  • The governments review and approve proposals from private insurance companies
  • They assess for price, value, and consistency with Affordable Care Act

The health insurance marketplace consists of federal and state-run organizations that manage systems for reviewing and buying health insurance plans. The marketplace consists Web portals, telephone personnel, and physical office locations.

The overall purpose is to qualify health insurance plans and connect consumers with the cost and financial assistance programs in the Obamacare marketplace.

The federal and state governments ensure that all marketplace plans meet the requirements of the Affordable Care Act and the individual mandate.

Comparison shopping is an ideal way to review and assess marketplace health insurance plans. Using comparison shopping, consumers can focus on the features that matter most to them.

Enter your zip on our site to get free health insurance quotes!

Individual Mandate

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The individual mandate is the tax penalty provision of the Affordable Care Act. It spells out the individual shared responsibility payment that occurs when eligible residents fail or refuse to get qualified coverage.

The Obamacare marketplace provides policies that meet the requirements of the law and satisfy the mandate. Buyers of marketplace plans avoid the penalty. Marketplace plans must exceed a required minimum level of value and contain the essential health benefits.

The Open Enrollment Period

The open enrollment period is a critical time in the operation of the Obamacare health insurance marketplace. It is the time when every eligible person has a right to buy affordable, qualified health insurance coverage.

The end of the open enrollment period closes signups for the year. Those that fail to buy coverage during the open enrollment period must find an exception or an extension.

Exemptions

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The marketplace must provide affordable insurance. For families and individuals, the cost may not exceed 8 percent of annual family income. If there are no affordable policies, the applicant can apply for an exemption.

The accepted federal exemptions include financial hardships. The policy includes a kind of forgiveness of one or two months without insurance.

If promptly redone, the federal government does not penalize one or two months without insurance coverage. The federal rules recognize a range of situations as exemptions to the mandate.

Extension of Open Enrollment

The federal government and each state that runs an exchange can extend the open enrollment period. Often they have done this to allow subscribers to finish their incomplete applications.

Comparison shopping can be particularly helpful during extensions. These are usually short periods and selecting a policy is an important action. Comparison shopping can go right to the features that matter most to the individual or family.

Exceptions to Closed Enrollment

The Obamacare marketplace forbids discrimination against subscribers on any basis except age, location, and tobacco use.

Pre-existing health conditions, gender, financial status, and medical history were among the discriminatory criteria banned by the Affordable Care Act. Insurers can no longer deny coverage to eligible applicants. Status changes that occur after open enrollment can qualify applicants for a new sixty-day enrollment period.

The Life Events

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Some changes in status require a new opportunity to buy or switch to new health insurance coverage.

They can be simple things like moving outside of the current insurer’s service area or more involved like getting married or having a child. The federal marketplace rules include the below-listed items as qualifying events for a special enrollment period.

  • Divorce
  • Marriage
  • Childbirth or adoption
  • Loss of health insurance coverage as a dependent at age 26

Medicaid, Medicare, and the CHIP

After the open enrollment, federal and state programs can provide qualified health insurance coverage. Obamacare uses household income to determine eligibility.

The below-stated descriptions show these programs meet the requirements for qualified health insurance.

  • Medicare is health insurance for elderly Americans. Eligibility depends on age, disability rating, and work history. Medicare Parts A and B and Medicare Part C exceed the standards for qualified coverage.
  • Medicaid is open to eligible applicants year-round. It offers comprehensive medical care to those below the income limits set by each state. The income limits can be lower than the federal poverty line; in some states, the Medicaid limit is about one-half of the federal poverty line
  • The CHIP provides medical and dental care for children and young persons in need. It is open for enrollment year-round and meets the requirements of the individual mandate for insurance coverage

Medicare Expansion

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The Medicaid Gap is the difference between the maximum income for Medicaid eligibility and the minimum income limit for Obamacare policies.

The incomes in between represent millions of Americans whose incomes are too low for marketplace policies and too high for Medicaid coverage. Against this background, the Congress enacted Medicaid expansion.

This change in law and the federal rules raised the Medicaid income limit to 138 percent of the federal poverty line. With expansion, those with too little income for marketplace policies could get coverage from Medicaid.

Reviewing The Obamacare Marketplace

The marketplace is a great place to review and purchase health insurance. Consumers can learn the basic ideas about health insurance that enable good decisions.

The individual mandate requires constant health insurance coverage. Consumers can go into depth on the characteristics of managed care and the variations of health management organizations and preferred provider organizations.

Financial and Costs Assistance

AdobeStock_62082716-1600x1600 (1)The Obamacare marketplace provides the economic benefits of the Affordable Care Act. The staff resources answer questions and assist consumers in making selections.

For eligible consumers, the Act enables tax credits to reduce the amount they must pay in monthly premiums.

These valuable subsidies make premiums affordable. They provide information on costs reduction assistance, help with out-of-pocket expenses, and ways to reduce the impact of deductibles.

Four Types of Plans

The Obamacare marketplace offers four types of plans. They carry names of metals to help consumers compare plans with similar splits of insurance payments to consumer payments for covered benefits.

The types of plans come with many variations. They can be HMO, PPO, POS, and EPO styles of managed care. The below listed items describe the value based types of Obamacare marketplace plans.

  • Platinum plans provide the highest ratio of coverage. Platinum plans pay 90 percent of the benefits leaving 10 percent for the consumers. Platinum plans have the highest premiums and lowest levels of deductibles and out-of-pocket expenses.
  • Gold plans provide coverage at a split of 80 percent insurance payment to twenty percent consumer payment. These plans have high premiums
  • Silver plans divide costs at the ratio of 70 percent to 30 percent. Silver plans with high deductibles make ideal pairs with Health Savings Accounts. These high-deductible silver accounts combine high levels of insurance coverage with a financial strategy to pay deductibles, coinsurance, and other out-of-pocket expenses.
  • Bronze plans offer a 60 percent to 40 percent split with the consumer. These plans have the lowest premiums and highest deductibles. They have high out-of-pocket costs but qualify for costs reduction assistance.

Types of Managed Care

The marketplace offers a wide variety of approaches to managed care. Most plans are HMO which requires a primary care doctor and referrals for network services.

The second largest group is the Preferred Provider Organization (PPO). The preferred provider system permits easy use of network resources. Consumers that go outside of the network can do so but will pay a higher portion of the fees.

The POS or point of service system allows referrals to outside resources with insurance coverage. The EPO or exclusive provider network has a simple in-network only approach.

The Marketplace Serves Everyone

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The health insurance marketplace is a robust system for selecting, renewing, or replacing health insurance. It manages a national platform for health insurance that oversees costs, costs efficiency, and promotes economy for consumers. It makes compliance with the individual mandate simple and easy.

The federal marketplace and state agencies work actively and passively with insurers on costs. They promote the consumer’s interests in high quality and low prices. Consumers can review and purchase plans online.

Comparison shopping is the ideal way to use the health insurance marketplace.

At any income level, comparison shopping will focus the search on the features that consumers use most. Start shopping for health insurance today by entering your zip in our free search box below!

Free Health Insurance Comparison

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