The Health Insurance Marketplace allows Americans to conveniently compare health insurance plans based on deductibles, costs, and coverage details. This service is provided through your state’s marketplace or the federally run exchange, depending on your residence. Small business owners can use the Small Business Health Options Program (SHOP) to compare and select plans for their employees.
This government-operated resource helps individuals, families, and small business owners:
The Marketplace has specific eligibility criteria for individuals seeking coverage and insurance providers offering plans. To qualify for Marketplace coverage, you must reside in the United States and be either a U.S. citizen or national. Individuals currently enrolled in Medicare are not eligible.
While Marketplace plans can differ, the ACA mandates that all available plans must provide coverage in ten key areas known as Essential Health Benefits (EHBs). Although these benefits may appear obvious, plans can sometimes provide limited coverage, and political debates have included proposals to remove these mandated benefits.
The required health benefits:
✔ Preventive and wellness services, including chronic disease management
✔ Mental health and substance use disorder services
✔ Pregnancy, maternity, and newborn care
✔ Rehabilitative and habilitative services
✔ Ambulatory patient service
✔ Prescription medications
✔ Laboratory services
✔ Emergency services
✔ Pediatric services
✔ Hospitalization
Enrollment in Marketplace plans occurs during a designated "open enrollment period." If you miss this period, you may still qualify for coverage during a "special enrollment period," which applies to certain life events, such as having a child, marriage, divorce, relocation, and starting a new job.
You and Your Health Insurance
While the Marketplace is designed to simplify the process of finding health coverage, it can still be challenging to determine which plan is right for your unique needs. Many individuals find it helpful to consult a local insurance agent to guide their decisions. You may be uncertain about choosing the most suitable plan for yourself and your family or have questions regarding special enrollment periods or premium subsidies.
When You Need Guidance…
Our local insurance agents can help you navigate the Health Insurance Marketplace, ensuring you select the best plan for your circumstances and budget.
Phone: (469) 205-6888
Email: jon@jonnolaninsurance.com
Office Hours:
Monday to Friday: 8 am to 5 pm
After hours:
Saturday & Sunday - By phone or appointment
