During the early 2010s, there was a significant transformation in the realm of health insurance within the United States. The Obama Administration initiated efforts to make health insurance more accessible to all American citizens. Prior to this initiative, approximately one in six Americans lacked medical insurance coverage. Acquiring plans outside of employer sponsorship was notably pricier and more convoluted compared to the present scenario, leading to the establishment of the Health Insurance Marketplace.

Important points to note include:

• Eligibility for purchasing health insurance from the Marketplace is open to everyone, although meeting income criteria is necessary to qualify for a tax credit.
• All plans available through the Marketplace adhere to ACA regulations, ensuring specific consumer protections within your health insurance.
• Dental coverage typically requires a separate plan from health insurance, while vision coverage is consistently separate except when included in plans for children.
• The open enrollment period for Marketplace plans extends until January 15, 2023, with coverage commencing as early as January 1, 2023.

What is Marketplace health insurance?

Marketplace health insurance offers a means to acquire health coverage independent of employer sponsorship.

Non-employer-sponsored plans may be termed as:

• Private medical insurance
• Marketplace insurance (Health Insurance Marketplace)
• Insurance exchange
• Affordable Care Act (ACA) insurance

Reasons to buy Marketplace insurance

You can obtain private insurance outside the health insurance Marketplace by purchasing directly from an insurance plan or collaborating with an insurance broker. While Marketplace plans typically offer more economical options, there are instances where purchasing outside the Marketplace is preferable, particularly for specialized care needs. Unlike Marketplace plans, there is no income requirement for eligibility; however, if your household income surpasses a certain threshold, you may not qualify for a special tax credit.

Here are some reasons you might consider purchasing Marketplace insurance:

• You are self-employed.
• You are choosing not to enroll in an employer-sponsored health plan.
• You are currently unemployed.

To qualify for Marketplace insurance, you must:

• Not be on Medicare.
• Reside in the United States.
• Be a United States citizen.
• Not be incarcerated.

Marketplace plans are available for individuals or families. The premium tax credit is determined based on an income sliding scale, and eligibility can be checked on healthcare.gov.

Where to purchase Marketplace insurance: To purchase Marketplace insurance, you’ll need to create an account on Healthcare.gov. Ensure you check if your state offers its own Marketplace option.

The Marketplace provides five plan types, which include:

• Catastrophic
• Bronze
• Silver
• Gold
• Platinum

The catastrophic plan features a very low monthly premium but high healthcare costs and is best suited for “emergency-only” coverage. It includes a high deductible but covers three preventative visits annually outside of your deductible. On the other hand, platinum plans have high monthly premiums but lower deductibles and medical expenses when receiving care.

Additionally, there are various network plan types (PPO, HMO, EPO, and POS), which determine how your insurance defines in-network and out-of-network providers and facilities. Typically, a wider network entails a higher premium because it offers more care options.

Elements of Marketplace plans

Marketplace plans offer the advantage of providing private plans that comply with the ACA, similar to the requirement for employer-sponsored health plans. This ensures the implementation of consumer protections to guarantee fairness and regulation for consumers. Some of these regulations include provisions such as allowing individuals to remain on a parent’s plan until the age of 26 and coverage of essential health benefits.

Marketplace health plans are mandated to cover a range of essential services, including:

• Medications
• Hospital care
• Preventative care
• Laboratory services
• Emergency care
• Mental health care
• Rehabilitation services
• Pregnancy care

What about Dental and vision?

When considering dental coverage within the Marketplace, it’s important to note that you typically can’t purchase a standalone dental plan without opting for health insurance. While some health insurance plans may include dental care, in other cases, you may need to obtain dental coverage separately. It’s mandatory for all insured children to have access to dental coverage, although parents have the flexibility to choose whether or not to elect this benefit. It’s essential to remember that dental coverage cannot be altered or removed outside of the open enrollment period.

As for vision care, it’s generally not provided through the Marketplace, although some plans may offer it as part of their coverage. If vision care, including services like glasses, contact lenses, vision exams, or eye surgery, is a priority for you, it’s advisable to consult with an insurance broker to ensure you receive adequate coverage. Similar to dental care, vision coverage must be available to all individuals under the age of 18.

Pregnancy and contraception cases

Pregnancy coverage begins from the start date of your health plan under Marketplace plans. Moreover, these plans also provide coverage for birth control methods and counseling. It’s noteworthy that all Marketplace plans are obligated to cover pregnancy without imposing co-payment or coinsurance for in-network providers, even before meeting the deductible requirement. Furthermore, all plans are required to include coverage for breast pumps and lactation support post-pregnancy.

Don’t miss open enrollment for 2024

Like employer-sponsored health insurance, Marketplace plans operate within an open enrollment period. Outside of this designated period, individuals cannot enroll in a Marketplace plan unless they encounter a qualifying life event.

Qualifying life events may encompass:

• Relocation to a different zip code
• Release from incarceration
• Job loss
• Marriage
• Birth of a child
• Divorce
• Attainment of citizenship
• Loss of coverage due to the death of a family member

It’s essential to remember to explore the market for a private plan by January 15th, 2024. Coverage for these plans begins at the earliest on January 1st, 2024.