What is the Health Insurance Marketplace?
Health Insurance Marketplaces (also known as Exchanges) are set up to create more organized and competitive markets for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and provide information to help you understand your options. Through the Marketplace, individuals and families will be able to shop for health care coverage if they need to buy health insurance on their own. Premium and cost sharing subsidies will be available through the Marketplace to reduce the cost of coverage for individuals and families, based on income. Individuals and families with very low incomes will also be able to find out if they are eligible for coverage through Medicaid and Children’s Health Insurance Program (CHIP). Finally, small businesses can buy coverage for their employees through the Small Business Health Options Program (SHOP) Marketplace.
There will be a health insurance Marketplace in every state for individuals and families and for small businesses.
If you have questions don’t hesitate to give us a call. We know this can be confusing and we’re here to help.
Who is eligible for Marketplace premium tax credits?
Premium tax credit will be available to U.S. citizens and lawfully present immigrants who purchase coverage in the Marketplace and who have income between 100% and 400% of the federal poverty level.
Individuals who are eligible for coverage through Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, or the military or have access to health insurance through an employer are not eligible for a premium tax credit. (There is an exception in cases when the employer plan is unaffordable because the employee share of the premium exceeds 9.5% of the employee’s income. There is also an exception in cases where the employer plan doesn’t provide a minimum level of coverage.
Can I use the premium tax credit to reduce the cost of any Marketplace health plan?
You can apply the premium tax credit to any Bronze, Silver, Gold, or Platinum plan offered through the Marketplace. Premium tax credits cannot be applied to Catastrophic plans or to stand-alone dental plans. If you are also eligible for cost sharing reductions, these can only be obtained through Silver plans offered in the Marketplace.
How do I find my state marketplace?
A list of state marketplaces is available at www.healthcare.com
I notice Marketplace plans are labeled “Bronze,” “Silver,” “Gold,” and “Platinum.” What does that mean?
Plans in the Marketplace are separated into categories — Bronze, Silver, Gold, or Platinum — based on the amount of cost sharing they require. Cost sharing refers to health plan deductibles, co-pays and co-insurance. For most covered services, you will have to pay (or share) some of the cost, at least until you reach the annual out of pocket limit on cost sharing. The exception is for preventive health services, which health plans must cover entirely.
In the Marketplace, Bronze plans will have the highest deductibles and other cost sharing. Silver plans will require somewhat lower cost sharing. Gold plans will have even lower cost sharing. And Platinum plans will have the lowest deductibles, co-pays and other cost sharing. In general, plans with lower cost sharing will have higher premiums, and vice versa.
Will I be charged more because I have a pre-existing condition? What about my age?
No. Starting in 2014, as insurance policies are sold or renewed, health plans are not allowed to charge you more based on your health status or pre-existing condition.
However, in most states you can be charged more because of age. Federal rules allow insurers to charge older adults (for example, someone in their 60”s) up to three times the premium that would charge younger adults (for example, someone in their 20’s).
What is the penalty if I don’t have coverage?
The penalty for not having minimum essential coverage is either a flat amount, or a percentage of household income, whichever is greater. The penalty will be phased in.
In 2014, the penalty is the greater of
- $95 for each adult and $47.50 for each child, up to $285 per family, or
- 1% of family income minus the federal tax filing threshold, which is $10,000 for a person who files singly, $20,000 for somebody who files jointly