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ObamaCare | Health Insurance Exchange

The ObamaCare Health Insurance Exchange Marketplace opened Oct 1st, 2013. The ObamaCare health insurance exchanges, or ObamaCare exchanges, are online marketplaces for health insurance. Americans can use their state’s “Affordable” Insurance Exchange (Marketplace) to obtain coverage from competing private health care providers. Shoppers can use a price calculator to see if they qualify for cost assistance subsidies as well as Medicaid and CHIP and see side-by-side comparisons of qualified health plans ensuring the best deal for them and their family.

Open enrollment in the health insurance Marketplace started November 15th, 2014 and ends February 15th, 2015.  You won’t be able to sign up outside of open enrollment without qualifying for a special enrollment period. Don’t miss your chance to avoid the fee and get cost assistance!

The Health Insurance Marketplace: What Every American Should Know

The health insurance marketplaces (also known as exchanges) are estimated to provide up to 29 million people with affordable health insurance by 2019.  Here are the most important things to know about the marketplaces going into open enrollment 2015.

•  During open enrollment, you can use the marketplace to enroll in a new plan, change plans, verify cost assistance, enroll in Medicaid and CHIP, and to apply for cost assistance.

•  Cost assistance, which can include premium subsidies and out-of-pocket subsidies depending on income, is only available through the marketplace and can only be used in marketplace plans.

• You must obtain or maintain minimum essential coverage (all marketplace plans are minimum essential coverage), or qualify for an exemption, during open enrollment to avoid owing the per month fee for not having coverage.

• In the individual and family market, open enrollment is the only time you can switch plans or buy a new plan, this is true whether you use the marketplaces or shop outside of the marketplaces.

• If you miss open enrollment you won’t be able toBuy A Major Medical Health Planthat counts as minimum essential coverage unless you qualify for a special enrollment period.

• Open enrollment for ObamaCare’s health insurance marketplace for 2014 went from Oct 1st, 2013 to March 31st, 2014.

Open enrollment in the health insurance marketplace for 2015 goes from November 15th, 2014 to February 15th, 2015.

• Coverage purchased on the marketplace by the 15th of each month starts the 1st of the following month.

• You had to have coverage by the end of each year’s open enrollment to avoid the per-month fee for not having health insurance for that year. This is due to a coverage gap exemption from the individual mandate that allows every American three months in a row without insurance.

• Everyone can use the marketplace (unless you qualify for Medicare, Medicare isn’t part of the marketplace). If you don’t like your current plan or don’t have insurance you should apply for the marketplace today to see your options. Applying doesn’t mean you have to enroll.

• Even though anyone can use the marketplace, only thosewithoutemployer-based health coverage options and those making less than 400% of the Federal Poverty Level (FPL) are eligible for cost assistance.

• No one has to use the marketplace. If you don’t qualify for Medicaid or cost assistance it may be wise to see your optionsOutside Of The Marketplace . Not all health insurance providers offer plans on the marketplace. Please note that while your options may be different depending on where you shop each specific major medical plan must be sold at the same premium (before cost assistance) regardless of where you get the plan.

• Private insurance outside of the marketplace has no official open enrollment period, however, almost all providers have unofficially adopted ObamaCare’s open enrollment periods. You won’t find health insurance options that protect you from the fee outside of open enrollment periods in most cases.

• If you have Medicare Part A or Medicare Advantage, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage, you are considered to have minimum essential coverage and are protected from the fee.

• Some additional rules apply for working seniors, high-income seniors, and those with Medigap insurance. ObamaCare and Medicare.

• Exchanges are either State, Federal or join-run depending on your State. You can find your state’s marketplace here.

• By the end of open enrollment, 2014 8 million Americans have enrolled in a marketplace plan, and 6 million enrolled in Medicaid or CHIP through the marketplaces.

Marketplace Cost Assistance Subsidies Facts

• Tens of millions of Americans who will qualify for cost-assistance offered exclusively through the marketplace!

• In 2014 alone 85% of the 8 million who enrolled inPrivate Insurancegot cost assistance.

• 6 in 10 Americans without insurance may get insurance for $100 a month or less.

• There are three types of cost assistance offered through the Health Insurance Marketplace to those making under a certain amount of income who don’t have access to employer-based insurance.

• Medicaid and CHIP for those making less than 138% of the Federal poverty level (FPL).

• Help with out-of-pocket costs for those making up to 250% of the FPL.

• Premium tax credits to reduce monthly premiums for those making up to 400% of the FPL. Premium tax credits can be claimed in advance (paid directly to your insurer and then taken off your premium) or deducted from your year-end taxes (you pay your premium and deduct the cost from MAGI).

• You may qualify for both premium and cost-sharing subsidies since they are not mutually exclusive. However, you cannot qualify for Medicaid and other marketplace subsidies since Medicaid includes them already.

• If you have work-based coverage, you can apply, but you won’t be able to get subsidies.

• The Official Website of the State Health Insurance Marketplace is healthcare.gov. Learn more about the Health Insurance Marketplace website works by watching the video below:

Health Insurance Exchange: Don’t Wait to Enroll in the Health Insurance Exchange Marketplace

The Health Insurance Exchanges are State specific marketplaces for health insurance. Americans making under 400% of the Federal poverty level can use their State’s marketplace to buy Federally regulated, subsidized private health insurance from competing providers.

You can apply today to see if you qualify for subsidies! You can only enroll during open enrollment each year, but you can apply for the marketplace at any time to see if you qualify for cost assistance.

Those who don’t obtain and maintain insurance, or an exemption, will be charged a fee on their income tax returns for each month they go without coverage. Keep reading our unbiased breakdown of the exchanges and how the marketplaces work to get the inside scoop before you buy your health insurance.

How to Sign Up For The Health Insurance Marketplace

There are four ways to sign up for your State’s Health Insurance Marketplace.

1) Find your State’s marketplace website.

2) Get in-person help. You can find in-person help by going to LocalHelp.Healthcare.gov.

3) Call the 24/7 marketplace helpline 1-800-318-2596.

4) Mail in a paper application. bit.ly/PaperApplication. (read these instructions first)

State Health Insurance Exchange, Federal Health Insurance Exchange and Join-run Exchange

ObamaCare’s State Health Insurance Exchanges can be run in different ways. States can build a health insurance exchange (HIX) on their own, partner with one or more other states, run a joint exchange with the Federal Government or have the Federal Government build and run the insurance exchange for them. All exchanges had to be fully operational by October 1st, 2013. Only State’s who built their own exchange receive full Government funding for the marketplaces.

States that set up their own exchange directly determine which companies can compete in their exchange and negotiate benefits and prices. In a federal exchange, the U.S. Department of Health and Human Services (HHS) does this for them. In a join-run exchange, any carrier meeting the minimum Federal and State requirements can compete in the exchange.

Today all states have operational marketplaces.

Ready to sign up for health insurance? Findyour State’s health insurance marketplace now.

You can see the details on each health insurance exchange at commonwealthfund.org to understand which parts of each marketplace are federally run and which are handled by the state.

Health Insurance Exchange or Health Insurance Marketplace: Understanding the Semantics

A health insurance exchange is a marketplace for purchasing health insurance. Thus we could call them exchanges or marketplaces, and we would be talking about the same thing. The official term when talking about Americans using the exchange is “health insurance marketplace.” However, the Affordable Care Act itself refers to them as exchanges. Each State-run exchange has its unique name.

The health insurance exchange can also be referred to as the HIX, ObamaCare Exchange, Health Benefits Exchange, Health Care Exchange, Health Insurance Marketplace and Affordable Insurance Exchanges. The terms are all interchangeable, just like ObamaCare is also called Health Care Reform, the Affordable Care Act, ACA, etc.

ObamaCare Exchanges: State Health Care Exchange Time Line

The states had until November 16th, 2012 to submit a declaration letter of how they will handle their state health insurance exchange.

States who were going to run their own “ObamaCare” exchanges had until December 14th, 2012 to submit an initial Blueprint application. The HHS approved the state’s exchange on Jan 1st, 2013.

The final deadline for both the Declaration Letter and Blueprint Application for State Partnership Exchanges was extended to Friday, February 15, 2013. All State’s are expected to have their exchanges open for October 1st, 2013. The states were able to apply for funds from the federal government for assistance with the exchange. Get the Update on Your State’s State Health Insurance Exchange.

How Do The ObamaCare State-Run Health Insurance Exchanges and Federal Run Exchanges Work?

The ObamaCare health insurance exchanges allow all Americans above the poverty line to be able to buy health insurance through providers via an online health insurance marketplace. The marketplace also offers subsidies for lower cost premiums, lower out-of-pocket costs, and Medicaid. The health insurance marketplace works similar to a car insurance website where side-by-side cost and benefit comparisons of different tiered plans are displayed to help the shopper purchase the best coverage for them and their family.

• If you have Medicare, you cannot, in most cases, purchase another insurance plan. This includes a marketplace plan.

• If you have access to qualifying employer-based insurance you cannot get subsidies.

• Each health care provider tries to attract customers by providing affordable quality health care packages.

• You can compare coverage options using an online calculator to figure out which plan is right for you.

By enrolling in the exchange you will automatically be shown prices that reflect your savings after tax credits. Please note only those making under 400% of the Federal Poverty level will be eligible for tax credits and only those below 250% are eligible for out-of-pocket assistance.

The Department of Health and Human Services (HHS) administers the requirements for the exchanges and the health plans that can be sold on the exchange. This measure of quality assurance ensures that any plan bought on the exchange meets certain requirements, increasing consumer protection.

Watch Movie Videos on the Health Insurance Marketplace

What Type of Plans Are Available on the ObamaCare Exchange?: Bronze, Silver, Gold and Platinum

There are four tiers of “qualifying health plans” or “metal plans” you or your employer can purchase on the exchange. They range from lower quality, but more affordable “Bronze plans,” to “Silver plans” to a more expensive plan with better coverage called a “Gold plan.” There is also a “Platinum plan” which is the highest quality and cost plan. Lower premium plans will have higher deductibles, fewer benefits and larger out of pocket costs. All plans offer at least ten essential health benefits including free preventive services. Get more details on each of the Qualifying Health Plans.

Qualifying Health Plans: Minimum Benefits Required by ObamaCare for Plans Sold on the Health Care Exchange

Qualifying Health Plans are plans that meet the minimum standards set forth by ObamaCare. All plans sold on and off the ObamaCare Health Care Exchange must include the following ten essential health benefits to be considered a Qualifying Health Plan:

1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management

10. Pediatric services, including oral and vision care


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