Now, almost every American is required to have a health insurance plan. This change also introduced several new additions to healthcare plans. Below, you’ll find some questions and answers about the changes.
What is a Health Insurance Marketplace (also known as an Exchange)?
Every state has a marketplace for consumers to shop for health insurance. These are called Health Insurance Marketplaces. Consumers can shop, compare and select a plan that best suits their needs. The Health Insurance Marketplaces allow consumers to do their shopping online, in-person, over the phone, or by mail. Consumers can look at information such as the provider network, benefits, premiums, deductible costs, co-pays, and co-insurance requirements before selecting a plan. Some states have their own marketplaces, also known as state-based exchanges (SBEs). Other states use healthcare.gov.
Who's eligible for a plan on the Health Insurance Marketplace?
Anyone can search online for a healthcare plan on their state’s Health Insurance Marketplace. The requirements to get insurance through the Marketplace are:
- Meet applicable state residency requirements
- You must be a U.S. citizen, national, or noncitizen who is lawfully present
- You cannot be currently incarcerated
If you currently receive health insurance coverage from your employer, you likely will continue to receive this coverage. If employer coverage is considered too expensive, you might be eligible to find coverage through your marketplace.
How does this affect me?
Today, almost every American will need to have insurance coverage through their employer, through Medicaid or Medicare, or they will need to buy health insurance. There are some exceptions for religious groups and some financial situations. If you don’t have coverage, you may be subject to a fine, in the form of a tax penalty.
What are the healthcare coverage changes?
Here are some of the main changes:
- Coverage for those with pre-existing conditions. If someone has a pre-existing condition, such as diabetes, pregnancy, or a history of heart problems, they are able to obtain coverage.
- No lifetime limits. Health insurance coverage won’t run out when someone reaches a certain dollar amount limit.
- Increased coverage for children. Dependents can stay on a parent’s healthcare plan until they are 26 years old. Some states may increase this age limit.
- Free preventive care for women. Some of these services include:
- Breastfeeding support and supplies
- Well woman visits
- FDA-approved birth control methods
- Gestational diabetes screenings
- Conditions for coverage. The individual factors that will determine the price of your health plan are your age, where you live, and whether or not you smoke.
- Increased preventive care. Annual checkups and many preventive care services will now be free. Examples include blood pressure tests, annual wellness exams, and colon cancer screenings for adults over 50. There are 10 core categories of health benefits that qualified health plans will be required to include. These are called Essential Health Benefits.
How much will plans cost?
The cost of plans varies by the type of plan you choose. However, you may be eligible for discounts on your plan to help lower your monthly premium amount and other healthcare amounts. These are known as Subsidies and Cost-Sharing Reductions. Learn more on our Healthcare Savings page! You can also use our helpful Subsidy Estimator to see if you are eligible for a Subsidy. If someone doesn’t receive a subsidy due to income status, they are still able to shop for a health plan on the Health Insurance Marketplaces.
What is the Federal Poverty Level (FPL)?
This is the set minimum income a family needs for food, clothing, transportation and shelter. The government decides this level. It depends on the size of your family. For more information on the Federal Poverty Level, visit healthcare.gov.
What is the timeline for all of this?
This year, open enrollment on the Healthcare Insurance Marketplaces is from November 1, 2016 – January 31, 2017. Following this initial enrollment period, open enrollment will typically be every fall.