The Health Insurance Marketplace is a platform that offers insurance plans to individuals, families, and small businesses. The Affordable Care Act (ACA) established the Marketplace to extend health insurance coverage to millions of uninsured Americans. Many states offer their own marketplaces, while the federal government manages an exchange open to residents of other states.
The Health Insurance Marketplace was established to make it possible for people in the USA to evaluate the various types of health insurance for deductibles, cost, and coverage. This resource is operated by the federal government or by your state, depending on where you live. Small businesses can shop for health insurance at the Small Business Health Options Program (SHOP), where small business owners can compare plans to offer their employees.
What is the Health Insurance Marketplace?
This government resource is designed to make it easy for individuals, families, and small business owners to:
- Compare the available health insurance plans in your state
- Discover any tax credits related to health insurance
- Determine eligibility for Medicaid or CHIP (Children’s Health Insurance Program)
ACA Health Insurance Marketplace Requirements & Benefits
The Health Insurance Marketplace has requirements for individuals and families who use it, as well as for the insurance companies that offer coverage. To be eligible for Marketplace coverage, you must live in the United States and be a U.S. citizen or national. If you are covered by Medicare, you’re not eligible.
While the plans that insurers offer on the Marketplace can vary widely, the ACA requires that they must each satisfy 10 basic requirements or essential health benefits (EHBs). Many of the EHBs might seem like they would go without saying, but plans can skimp on basic coverage and some political opponents of the ACA have proposed eliminating EHBs since the passage of the ACA.
The required health benefits:
- Ambulatory patient services
- Emergency services
- Laboratory service
- Mental health and substance use disorder services
- Pregnancy, maternity, and newborn care
- Prescription medications
- Preventive and wellness services and chronic disease management
- Pediatric services
- Rehabilitative and habilitative services
Open Enrollment on the Health Insurance Marketplace
The Marketplace has a specific “open enrollment period.” If you missed the open enrollment period, you may still be able to get health insurance during a “special enrollment period.” You become eligible for a special enrollment period for specific life events, such as having a child, getting married, divorced, moving, or a new job, and some others.
You and Your Health Insurance
While the Marketplace is geared to help people identify the right health insurance, it can be surprisingly difficult to know what policy to choose. Many people choose to work with a local insurance agent for guidance. You may not be sure which plan is best for you and your family, or whether you are eligible for special enrollment or enhanced subsidies that can help you pay your premiums.
When You Need Guidance…
Our local agents are available to help you navigate the Marketplace and choose the health insurance plan that will be best for your situation and budget.