Q: What is the Health Insurance Marketplace?
The Marketplace is an informational resource you can visit online to shop for, compare and purchase health insurance coverage under the Affordable Care Act. The Marketplace will inform you if you qualify for low income tax credits to lower the cost of insurance. It will also let you know if you qualify for Medicaid coverage and will help you with Medicaid enrollment. In Ohio, the federal government operates the Marketplace. You can contact the Marketplace by visiting www.healthcare.gov
or by calling (800) 318-2596.
Q: Who can shop for coverage in the Marketplace?
A: The Marketplace offers coverage to individuals and families. Small employers with fewer than 50 full time workers can also buy Marketplace coverage for their workers, but large employers with more than 50 full time workers cannot buy coverage on the Marketplace at this time.
Q: What kind of health insurance does the Marketplace sell?
A: The Marketplace sells health insurance offered by private insurance companies. Marketplace insurance is comprehensive and covers medical services including hospitalization, physician services, maternity, mental health, substance abuse, prescription drugs, lab tests, preventive services, medical devices, rehabilitation, pediatric dental and vision, and other services required by law.
Q: Will the coverage sold through the Marketplace pay for all my health care?
A: In most cases, the health insurance sold by the Marketplace has copays and deductibles requiring you to pay for a part of the cost of health care when you receive it. You can choose from plans with different copays and deductibles to meet your needs.
Q: How much do Marketplace health insurance premiums cost?
A: Cost varies. Visit the Marketplace to learn what plans are available to you and how much each plan’s premium rate will be. The rate you will have to pay for insurance depends on your age, where you live, your income level and whether you use tobacco. These premium rates are designed to be affordable, so if your income is low, your premiums will also be low, and if you are eligible for Medicaid, you will pay no premiums. For most people, however, health insurance purchased through the Marketplace likely will cost several hundred dollars per person per month.
Q: Can I buy health insurance coverage anytime I want?
A: No. Health insurance is offered to anyone who applies, but only during open enrollment periods. If you are buying coverage on your own (not through an employer), the open enrollment period for 2016 began on November 15, 2015 and ended on January 31, 2016. As a result, open enrollment in the individual market is now closed.
After January 31, 2016, you may enroll in coverage only under special circumstances, such as when you lose employer coverage. Check with the Marketplace, a health insurance company or an insurance agent to see if you qualify for a special enrollment opportunity. The next open enrollment period for individual market coverage begins on November 1, 2016 and ends on January 31, 2017 for coverage in the 2017 calendar year.
It is important to understand that employers also have open enrollment periods for workers to enroll in an employer plan, but the open enrollment periods for employer plans may differ from the open enrollment periods for coverage you buy directly from an insurer. If your employer offers coverage, check with your employer as to whether you are eligible and when you can enroll.
Q: What if I already have coverage?
A: If you have employer coverage, you can stay on your employer’s health plan. If you have individual coverage, you can shop for new health insurance in the Marketplace during the next open enrollment period or keep your current policy.
Q: Does having employer coverage affect my ability to get low income subsidies through the Marketplace?
A: Yes. If your employer offers coverage that meets certain federal standards, you will not be eligible for low income subsidies through the Marketplace. Generally, if the coverage your employer provides is at least as good as coverage sold on the Marketplace, and your employer makes a minimum contribution toward the cost of coverage, you will not be able to get a low income subsidy on the Marketplace. If you do have employer coverage available to you, you should compare the costs and benefits of your employer’s health plan to the costs and benefits of the health insurance offered on the Marketplace. Check with your employer to find out the details of your employer’s health plan, and to see if your employer’s plan meets the federal minimum requirements.
Q: Where can I get more information about Marketplace coverage?
To get more information, or to shop for coverage, contact the Marketplace by visiting www.healthcare.gov
or by calling (800) 318-2596.
This “Law You Can Use” column was provided by the Ohio State Bar Association. It was prepared by Douglas L. Anderson, an attorney in the Columbus office of Bailey Cavalieri LLC.