Affordable Care Act

The Basic Facts

Health Insurance Marketplace – Exchange

A Health Insurance Marketplace, previously known as health insurance exchange, is a set of government-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies. All marketplaces must be fully certified and operational by January 1, 2014, under federal law.

When individuals use the Health Insurance Marketplace, they’ll fill out an application and see all of the health plans available in their area. They’ll find out if they can get lower costs on their monthly premiums for private insurance plans. They’ll learn if they qualify for lower out-of-pocket costs. The marketplace will also tell them if they qualify for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program (CHIP).

Individuals can apply for marketplace MEC three ways: online, by mail, or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat may be available. Open enrollment started October 1, 2013. Plans and prices will be available then. Coverage starts as soon as January 1, 2014.

Insurance plans in the marketplace are offered by private companies, and they cover the same core set of benefits called essential health benefits. No plan can turn the individual away or charge them more because they have an illness or medical condition. The marketplace must cover treatments for these conditions. Plans can’t charge women more than men for the same plan. While all insurance plans are offered by private companies, the marketplace is run by either the state or the federal government. If your state runs the marketplace, you’ll get health coverage through the state’s website.

The marketplace simplifies the search for health coverage by gathering the options available in your area in one place. Plans based on price, benefits, quality, and other features important to the buyer can be compared before a choice is made.

In the marketplace, information about prices and benefits will be written in simple language. The individual will get a clear picture of what premiums they’d pay and what benefits and protections they’d get before enrollment.

Employers can also buy health insurance through the Marketplace, through the Small Business Health Options Program (SHOP). Compare plans based on what’s important to you, and choose the combination of price and coverage that fits your needs and budget.

As stated above, a Full-time employee  may not qualify for lower costs on your monthly premiums or out-of-pocket costs. It will depend in part on their income and in part on whether the insurance the employer offers meets certain standards for cost and coverage. The employer should provide information to the Full-time employee to help determine whether the plan it offers meets those standards. If the employee chooses a plan other than the employer’s, the employer does not have to contribute to your premiums.

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