How to Use Your State’s Health Insurance Marketplace to Buy “Affordable” Health Insurance
ObamaCare’s Health Insurance Marketplace, or ObamaCare Marketplace, is your State’s price comparison website for subsidized health insurance. The following guide will explain the marketplace and how you, your family, and your business can compare health plans and qualify for reduced premiums and out-of-pocket costs on marketplace based coverage.
Open Enrollment in the Health Insurance Marketplace
ObamaCare’s Health Insurance Marketplace is open during each years annual open enrollment period. Open enrollment is the only time you can apply for cost assistance, enroll in a plan, or switch plans without qualifying for a special enrollment period . Enroll during open enrollment to avoid the per-month fee for not having insurance in 2015.
2015 open enrollment in the Health Insurance Marketplace started November 15th, 2014 and ends February 15th, 2015. Log in to your marketplace account and verify your plan before December 15th, 2014.
FACT: To avoid the penalty you need to obtain and maintain minimum essential coverage throughout the year. All marketplace coverage counts as minimum essential coverage.
Health Insurance Marketplace Facts
• Most Americans non-exempt will be required to have health coverage by 2014. Uninsured Americans can shop for coverage options in their State’s marketplace.
• No one can be denied coverage on the marketplace for health related reasons.
• Premium costs are no longer based pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry.
• The only factors that can affect premiums of new insurance plans starting in 2014 are your income, age, tobacco use, family size, geography and the type of plan you buy. This applies to all plans sold through your State’s health insurance marketplace.
• The marketplace is open to all Americans, but no one is required to use it.
• If you already have insurance you can keep it.
• You can compare competitively priced health plans through the marketplace to find the best deal for you, your family or your employees.
• Individuals and families earning less than 400% of the Federal Poverty Level can get cost assistance through the marketplace.
• Small businesses with under 50 full-time equivalent employees can use a part of the marketplace called “the SHOP” (Small Business Health Options Program).
• Small businesses with fewer than 25 full-time full-time equivalent employees with average annual wages below $50,000 can get tax credits to help pay for employee premiums through the SHOP.
• ObamaCare’s first open enrollment in your State’s marketplace ran from October 1st, 2013 to March 31st, 2014. Open enrollment for 2015 runs from November 15th, 2014 to February 15th, 2015. There is an open enrollment period every year as well as special enrollment periods.
• Medicare, health insurance marketplaces, and employer based insurance have open enrollment periods. Medicaid, CHIP and non-subsidized private insurance outside of the marketplace are not subject to mandatory enrollment periods, although most ObamaCare-compliant plans “known as Minimum Essential Coverage” can only be purchased during open enrollment inside and outside of the marketplace.
• Insurance purchased by the 15th of each month starts on the 1st of the following month after you paid your premium. Insurance purchased after the 15th starts on the 1st of the month after that.
• You can get an estimate of what your health insurance will cost on the marketplace by going to the healthcare.gov. Applying and enrolling in a plan are not the same thing, you are free to shop around for plans during open enrollment.
• Remember many states have their own marketplace, but healthcare.gov official health insurance marketplace.
Your State’s marketplace (AKA Exchange) is the official website for buying health insurance! The Marketplace opened October 1st, 2013 and closed March 31, 2013. All Americans had to obtain health insurance by January 1st, 2014 or pay a per month fee. However coverage gap exemptions technically gave you until May 1st, 2014 to be covered without owing the fee.
Listen to the President discuss ways to enroll in the Health Insurance Marketplace, give an update on the website, and discuss what the Affordable Care Act has done to benefit Americans so far:
The video above is an announcement made during open enrollment 2014, the first ever open enrollment period for the health insurance marketplace. Today the site is functioning smoothly and getting cost-assisted health insurance through the website is a breeze in most cases.
Why Use the Health Insurance Marketplace?
The main draw of the marketplace is they are set up to be an easy way for Americans to purchase quality subsidized insurance without the help of a broker. The marketplaces take the guess work out of buying health insurance and make coverage cheaper due to the competition created on the marketplace and access to cost-assistance. The only way for Americans to apply for premium health care tax credits is through the marketplace.
You can also use the marketplace to apply for Medicaid and CHIP. If you get insurance through work you can use the marketplace, but may not be eligible for tax credits. If you are eligible for Medicare please go to our page on Medicare enrollment, Medicare isn’t part of the marketplace.
Health Insurance Marketplace Technical Issues
The official ObamaCare website launched with a number of technical issues. However by the time the marketplaces closed 8 million had enrolled in individual and family plans and millions more had enrolled in Medicaid and CHIP through the marketplace.
Most of the issues with the Health Insurance Marketplace have been fixed as of December 1st, 2013. You can get the latest update on the status of the ObamaCare Website here.
Who Will Use the Health Insurance Marketplace?
The health insurance marketplace is for uninsured Americans looking for private individual and family plans and those eligible for cost assistance. The roughly 80% percent of Americans who already have health insurance either through an employer, privately or through a government program like Medicare or Medicaid not much will change under the Affordable Care Act.
• If you don’t have insurance and don’t have access to affordable, quality employer based insurance you can use the marketplace.
• If you make less than 400% of the Federal Poverty Level and don’t have access to employer based insurance, you may get cost assistance through the marketplace.
• If you make less than 133% of the Federal Poverty Level you will qualify for Medicaid if your state expanded Medicaid.
• 7 million Americans were projected to purchase private insurance on the marketplace in 2014. Over 8 million successfully enrolled in plans during open enrollment, exceeding goals by 1 million.
• 9 million Americans were projected to enroll in Medicaid or CHIP in 2014, which they can use the marketplace for.
• The Congressional Budget Office is projecting the rate of uninsured will drop by 14 million people in 2014.
• Medicare isn’t part of the marketplace, so those who have Medicare can keep it. NOTE: If you fill out an application on the marketplace and you qualify for Medicare you will be notified that you should apply for Medicare.
• The 170.9 million people covered by employer insurance won’t need to use the marketplace. Although many employers will use the marketplace to purchase group health plans via a part of the marketplace called “The SHOP” or the Small Business Health Options Program.
• The 101.5 million enrolled in government health programs won’t need to use the marketplace either.
Do I Have to Use the Marketplace if I Don’t Have Health Insurance?
ObamaCare’s “individual mandate” says that most legal residents in the U.S. must obtain health coverage, an exemption or pay a fee come 2014.
If you don’t get health insurance will have to pay $95 dollars or 1 percent of their annual income — whichever is higher. That amount will rise each year until it hits $695 or 2.5 percent by 2016. (it’s a little more complicated than that, so please see our individual mandate page for more information).
If you have health insurance already then you are most likely in the clear. If you make less than 400% of the Federal Poverty Level you will most likely qualify for free or low-cost health insurance through the marketplace so it is advised that you at least fill out an application. That being said, the marketplace is an option and not a requirement, you may buy private insurance through a broker or direct from a provider or obtain any other type of minimum essential coverage which include most common health insurance types. See our Guide to Health Care Plans here.
About the Marketplace: What is Affordable Insurance?
Affordable health insurance is health insurance that costs less than 8% of your families income. Please note that if insurance is obtained through an employer it can cost up to 9.5% of your income and still be considered affordable. If you can’t get affordable coverage you will most likely be exempt from having to purchased health insurance.
How Does the Health Insurance Marketplace Work?
The Health Insurance Marketplace works a lot other price comparison websites do. You go on your State’s marketplace and fill out some basic tax and medical history on your family. Then you can use a price calculator to get side by side comparisons of rates and benefits to compare health insurance plans and pick the best ones for you and your family.
There are three ways to apply for coverage from the health insurance marketplace: online, by mail, or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat will be available 24/7 to help you complete your application. This line is already open for those who have questions. Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)
Before you use the marketplace check out our complete guide to the insurance exchanges to find out how to save big and get the most bang for your buck!
Online Health Insurance Marketplace Enrollment:
When Does the Health Insurance Marketplace Open?
The Health Insurance Marketplace opened on October 1st, 2013. Open enrollment lasted until March 31st 2014. There are open enrollments each year. Open enrollment for 2015 starts November 15th, 2014.
Please note that you may qualify for special enrollment periods outside of open enrollment if you meet certain “qualifying life events” such as moving to a new state, changes in your income, and changes in your family size (for example, if you marry, divorce, have a baby, or become pregnant) you may get up to an extra 60 days to enroll.
Although insurance purchased through the marketplace can only be purchased during open enrollment to avoid the penalty for not having insurance, you can submit an application for health coverage outside of the Marketplace, or apply for Medicaid or CHIP, at any time.
Ways to Sign Up For The Health Insurance Marketplace
There are four ways to sign up for your State’s Health Insurance Marketplace.
1) Find your State’s marketplace website.
2) Get in person help. You can find in person help by going to LocalHelp.Healthcare.gov.
3) Call the 24/7 marketplace helpline 1-800-318-2596.
How to Sign Up For the Health Insurance Marketplace Website
Here are the official directions for signing up for health insurance through healthcare.gov.
- Set up an account. First you’ll provide some basic information. Then choose a user name, password, and security questions for added protection.
- Fill out the online application. You’ll provide information about you and your family, like income, household size, current health coverage information, and more. This will help the Marketplace find options that meet your needs. Important: If your household files more than one tax return, call the Marketplace Call Center at 1-800-318-2596 before you start an application.(TTY: 1-855-889-4325) This is a very important step. Please don’t skip it. Representatives can provide directions to make sure your application is processed correctly.
- Compare your options. You’ll be able to see all the options you qualify for, including private insurance plans and free and low-cost coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace will tell you if you qualify for lower costs on your monthly premiums and out-of-pocket costs on deductibles, copayments, and coinsurance. You’ll see details on costs and benefits to help you choose a plan that’s right for you.
- Enroll. After you choose a plan, you can enroll online and decide how you pay your premiums to your insurance company. If you or a member of your family qualify for Medicaid or CHIP, a representative will contact you to enroll. If you have any questions, there’s plenty of live and online help along the way.
Marketplace Qualified Health Plans = Minimum Essential Coverage
All health plans purchased through the marketplace (sometimes called an exchange) will qualify as minimum essential coverage (meaning you won’t have to pay the fee for not having insurance). You can also find out if you qualify for Medicaid, CHIP or Medicare through your State’s marketplace. We also provide more detailed guides to the exchanges and links to official and state resources for your State’s online health insurance marketplace.
After You Do Your Health Insurance Marketplace Research: Make sure to visit the Health Insurance Marketplace at to find out how to apply for your State’s Health Insurance Marketplace.
Qualified Health Plan: What Type of Coverage Can I Buy on the Health Insurance Market Place
Their are four tiers of Qualified Health Plans (plans that meet the minimum standards of ObamaCare including offering the 10 Essential Benefits) available on the exchange. Each tier of plan offers better benefits and less cost sharing. The plans are Bronze (with a 40% out of pocket cost on non-covered items), Silver (30%), Gold (20%) and Platinum (10%). Please be aware that high end plans carry a 40% excise tax. Affordable insurance assumes that you will buy a silver plan.
We cover the different types of qualified health plans in detail on our Complete Health Insurance Exchange Guide. Use our guide to find out which plan is right for you and your family.
Choosing the Right Qualifying Health on the Health Insurance Marketplace
Although it may be tempting to get a low end plan, you should consider you and your families medical history. While many things are covered without any out of pocket cost on all plans, higher premium plans have a smaller percentage of out of pocket costs. One trip to the hospital could more than make up the cost difference between a Bronze and Platinum plan for your family. Not all plans are created equal so make sure you shop around and look at every aspect of the plan and it’s network before decided which one is right for you.
Avoiding Premium Increases on Qualifying Health Plans
While you’ll never be charged more due to health status there are a few factors to consider to ensure low premiums. Be aware that when you sign up for the health insurance marketplace a fluctuation in income or the smoking status of a family member can increase costs drastically. ObamaCare focuses on wellness and you should too.
Do I Have to Shop for a Health Plan Before I Apply for a Subsidies?
In order to see if you qualify for subsidies the only thing you have to do is apply for the marketplace. When you compare plans the rates shown to you will reflect your subsidies.
You can get an estimate of what your health insurance will cost on the marketplace by going to the health insurance premium estimate tool from healthcare.gov.
Getting and Using Subsidies on the Online Insurance Marketplace
Cost assistance is offered in the form of premium tax credits or out-of-pocket subsidies through ObamaCare’s online health insurance marketplace for those who don’t have access to employer based coverage. If you make between 133% – 400% of the Federal Poverty Level (FPL) will automatically apply for cost assistance when they sign up for the exchange. These deductions will be taken out of your monthly premium costs. If you lose or gain income throughout the year it could cause you may be responsible for the difference on next years tax returns.
Please note that due to Medicaid Expansion in some States those below the 139% FPL may be eligible to receive Medicaid. If you or a family member qualifies for Medicare, Medicaid or CHIP they will not be able to receive cost assistance through the marketplace.
The three types of cost assistance are:
Medicaid / CHIP for those making less than 138% of the Federal poverty level (FPL) may get free or low-cost insurance from Medicaid or CHIP.
Help with out-of-pocket costs for those making up to 250% of the FPL
Premium tax credits for those making up to 400% of the FPL. You may qualify for both premium and cost-sharing subsidies as they are not mutually exclusive. Cost assistance is only available through your State’s health insurance marketplace.
|Types of Cost Assistance: Health Insurance Financing||Individual Annual Income||Family of Four Annual Income|
|Medicaid health coverage, if your state
decides to offer it
|Up to $16,105||Up to $32,913|
|Help to pay your premium, if you buy in
your state’s online marketplace
|Between $11,670-$46,680||Between $23,850-$95,400|
|Subsidies for out-of-pocket costs, if you
buy in your state’s online marketplace
|Up to $29,175||Up to $59,625|
Qualifying for Medicare, Medicaid or CHIP on the ObamaCare Marketplace
When you fill out your information you will also be made aware if you or any members of your house hold qualify Medicare, Medicaid or CHIP (children’s health insurance program). If you qualify for any of these programs you will not be able to purchase insurance through the exchange. Please the resources found on this site to ensure that you understand the parameters that you or your family member will need to meet to qualify for Medicare, Medicaid or CHIP. Understanding some of the variables could be the difference between getting in the program and not.
Purchasing Health Insurance Through the Online Marketplace
To sign up for health insurance either use our guide to finding your states insurance marketplace or simply use the healthcare.gov application page. Before you do we strongly suggest you research the marketplace using our site as we provide unbiased reviews, tricks and tips ensuring you get your best option at the best price.
Small Business Health Insurance Marketplace or “SHOP”
The Small Business Health Insurance Marketplace, otherwise known as the “SHOP” (Small Business Health Options Program), allows employers to shop for employee health insurance. Eligible employers can save up to 50% of their employees insurance costs using premium tax credits! Find out more about the SHOP Exchanges.
Purchasing Small Business Health Insurance Through the Online Marketplace
If you are looking to purchase employee health insurance through the online marketplace you will be using the SHOP online marketplace. SHOP stands for small business health options program, you can find out more information at our SHOP marketplace page or use the official healthcare.gov SHOP exchange resource to sign up now.
Regulated Insurance In the Marketplace
All insurance purchased through the online marketplace is heavily regulated. All plans must meet all the criteria of the law.
Healthy Competition In the Marketplace
Since health insurance companies must compete for your business they will have to offer better prices and plans to compete with other companies selling insurance on your State’s marketplace.
The Benefits of Health Insurance Purchased Through the Marketplace
All plans must include the 10 essential health benefits mandated by ObamaCare. From emergency services to newborn care ObamaCare ensures that some of your most essential benefits are covered under every plan. Find out more about the essential health benefits here.
Please note that if you need your insurance to kick in before 2014 it is not guaranteed the same protections and benefits as plans that kick in after the Jan 1st 2014.
Here is a quick and easy to read brochure to help you get ready for the health insurance marketplace.
Are People Enrolling in the Health Insurance Marketplace?
As of December 11th Health and Human Services (HHS), the department in charge of implementing and overseeing the Affordable Care Act, reported that:
- November’s federal enrollment number outpaced the October number by more than four times.
- Nearly 1.2 million Americans, based only on the first two months of open enrollment, have selected a plan or had a Medicaid or CHIP eligibility determination;
- Of those, 364,682 Americans selected plans from the state and federal Marketplaces; and
- 803,077 Americans were determined or assessed eligible for Medicaid or CHIP by the Health Insurance Marketplace.
- 39.1 million visitors have visited the state and federal sites to date.
- There were an estimated 5.2 million calls to the state and federal call centers.
Update: Over 8 million Americans enrolled in a marketplace plan during open enrollment 2014.
ObamaCare Website Glitches with the Health Insurance Marketplace
The ObamaCare website launched with some glitches, but work is already being done to correct the problem. Since October 1st, the official ObamaCare website for the health insurance marketplaces, healthcare.gov, has been having technical issues. For the State’s that created their own marketplaces most of the feedback has shown that they are working as intended if not better. The website glitches are being addressed now. The following video discusses what is going on with the health insurance marketplace glitches. Check out this article to get an idea of what is going on with the website.
Ready to Use the Health Insurance Marketplace?
If you think you know enough about the marketplace to use it now go and use our list of State Health Insurance Marketplaces to find your State’s marketplace. Alternatively you can keep reading our Complete Health Insurance Exchange Guide and our other resources on the online marketplaces to get a better understanding on how you and your family can find the best plan at the best price.
Using the Online Health Insurance Marketplace