How to Get Health Insurance Through the Marketplace

The health insurance marketplace is an online store at HealthCare.gov where people can shop, compare and enroll in various health insurance plans.

If you do not have adequate health insurance coverage in 2018, you’ll likely have to pay a penalty when you file your taxes.

The fee, or tax penalty, increases each year. For the 2017 tax year, the penalty is 2.5 percent of your annual income or $695 per adult ($347.50 per child) – whichever is higher. That penalty is paid on your 2017 tax return due April 2018.

If you apply for coverage through a health insurance marketplace, you may qualify for financial assistance or the premium tax credit to help offset the costs.

Federal or State Marketplaces

Many states operate their own health insurance marketplace.

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

Visit healthcare.gov to find out if your state operates a health insurance exchange or if you should utilize the federal government’s exchange.

The marketplaces allow you to shop for health insurance plans under five separate categories: bronze, silver, gold, platinum and catastrophic. Each category provides different levels of coverage and costs.

10 Essential Health Benefits

No matter which health plan you purchase through the exchange, it provided 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 – includes care after your child is born
  5. Mental health and substance abuse treatments — includes counseling, psychotherapy, and behavioral health treatment
  6. Prescription drugs
  7. Treatment for 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 – this is for vaccines, disease screenings, and counseling, as well as care needed to manage chronic diseases
  10. Pediatric care – includes dentistry and vision treatment for children

How to get health insurance

Enrollment opens Nov. 1, 2017. If you enroll by December 15, 2017, your coverage will start Jan. 1, 2018.

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 get started.
  • Get informational updates by following the federal marketplace’s Facebook and Twitter accounts. You can also sign-up for email or text updates.
  • Think about your household’s income and expenses to determine if you’re eligible for financial assistance. Pull together your tax forms and current pay stubs to help you figure out how much you can afford.
  • Create a budget.
  • 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.
  • Make a list of any questions.
  • Ask your human resource department if your employer will offer employer-sponsored health insurance in 2018.
  • 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.

Is the health insurance marketplace for you?

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

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

Keep in mind, if you choose a plan through the marketplace, your employer is not required to contribute to your coverage.

You must sign up for coverage if you don’t have insurance.

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.

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.

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