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What is a Health Insurance Marketplace and Who Should Care?

What is a Health Insurance Marketplace and Who Should Care - TaxACT

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:

  • Figure out if your state has a marketplace or whether you need to use www.healthcare.gov. Download a checklist to help you get started.
  • The federal marketplace has a Facebook page, a Twitter feed, or you can sign-up for email or text updates, so you will know when new and important information is coming out.
  • Think about your household’s income, expenses, and whether or not you are eligible for financial assistance. Pull together your tax forms and current pay stubs to help you determine how much you can afford.
  • Create a budget. Decide how much you can or cannot afford.
  • Study the different types of health plans and decide which one is not only affordable, but which gives you the right type of coverage for your situation.
  • If you have questions, make a list.
  • Ask your HR department if your employer will offer health insurance in 2014.
  •  If you need help, both the federal and state governments are offering counselors and navigators to assist you. A source for that is www.LocalHealth.HealthCare.gov.
  •  If you have questions, get help. Call the federal Health Insurance Marketplace at: 1-800-318-2596 any time of day or night, 7 days a week. TTY users can call: 1-855-889-4325. There is also online chat available through  www.healthcare.gov, which can be found in a blue box on the lower right hand corner of most of the website’s pages.

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.

Photo credit: Alex E. Proimos via photopin cc

About Mark Terry

Mark Terry is a freelance writer, editor and author specializing in healthcare and medicine. He lives in Michigan. Visit his website at www.markterrywriter.com.