The Health Insurance Marketplace is an online website that was constructed by the federal government built for the Affordable Care ACT (ACA) that began in 2013.  It is specially designed for individuals and families to shop online for an affordable health insurance plan of their choice.  The ACA marketplace works with individuals and families in qualifying states regardless of someone’s health status or income. For some states they have their own state exchange that works in a similar fashion to the health insurance marketplace but is facilitated by the specific state.

Here is how it works

You can enroll in a health insurance marketplace plan if you choose to depending on the time of the year.  However, you may not qualify for an affordable health plan if you are already covered by group health insurance through your employer.  Also, if you qualify for Medicare or Medicaid, then you will not qualify for a health insurance marketplace plan.  If you do qualify then the first step would be to create an account through or through a certified and licensed health insurance broker in your state.  Once you begin the online application there will be a series of personal household questions that include estimated income level, size of household, address, current coverage, SSN, etc.  Once the online application is completed the health insurance marketplace will generate all the health insurance plans in your area that you can choose from.  It will list the health insurance carrier’s name, the coverage, and the monthly premium cost.

Plan Types

The three most popular plan types are Bronze, Silver, and Gold.  In a limited number of states there is also the platinum plan option.  The plans are based on metal level tiers with bronze being the least expensive like the hierarchy of precious metals.

  1. Bronze Plan: It is the lowest cost plan but will have the least amount of coverage until the high deductible and out-of-pocket maximum is met. The coverage level is roughly 60% of your costs.  This plan is typically better suited for the healthy individual or family that does not use health insurance very often.
  2. Silver Plan: This is your mid-level plan. It will have a little bit lower of a deductible and better benefits before the deductible or out of pocket has been met.  This is for the people who want to have some benefits but keep their monthly cost from not being too high.  It covers roughly 70% of your healthcare costs.
  3. Gold Plan: This is your high-level plan in most states unless there is a platinum option. They will typically have the highest monthly premium cost, but you will get more benefits before deductible and out of pocket maximum has been met.  The coverage level is 80% of your costs.

For those who are under the age of 30, they may also qualify for a catastrophic plan.  These are considered to have the lowest monthly premium cost and are more like a bronze plan with the higher deductible and out of pocket maximum.  These plans are designed for the younger generation who typically are in better health because of age.

Government Financial Assistance

Other than pre-existing coverage being guaranteed the biggest benefit of the ACA marketplace is Americans being able to qualify for premium tax credits to offset a higher premium.

  1. Tax Credits/Subsidies: This is based mainly on income and household size.  The lower income level typically receives the largest subsidy to help pay for their health insurance premium.  However even a middle-class income household may qualify for a substantial monthly health insurance premium subsidy.
  2. Cost Sharing Reductions (CSR). If you qualify for a CSR, then you would need to enroll in a silver CSR plan.  You qualify for these plans typically if your household income is between 100% and 250% of the Federal Poverty Level (FPL).  The Silver CSR plans are very low-cost plans that sometimes may be $0 per month with low out of pocket maximums.

To qualify for government subsidies to reduce your health insurance premiums your household income must be between 100% and 400% of the FPL.  For states that have expanded Medicaid the household income must be between 133% and 400% of the FPL.

When to Enroll

  1. Open Enrollment Period (OEP): This period is typically between November 1st through December 15th each year. However, in some years it has been extended through January 15th.  This is the period that all Americans can shop and enroll on the health insurance marketplace.
  2. Special Enrollment Period (SEP): This period is for the remaining part of the year and is designed for those who have a qualifying life event.  Some SEP examples are losing employer-based health insurance, moving to a new county, income change causing a life event, getting married and gaining immigration status.  It can also be for people whose household income is between 100% and 150% of the FPL and want to change or select a new plan for the first time.

For more information on the health insurance marketplace contact to talk with a licensed and certified ACA marketplace agent.