Health Insurance Marketplace

The Patient Protection and Affordable Care Act requires most Americans to secure health insurance by 2014 or be charged a penalty.

Beginning October 1, consumers in Pennsylvania will have the option to begin to apply for new healthcare coverage options through a government-run exchange—also known as the Health Insurance Marketplace. The site Pennsylvanians will use to purchase healthcare is healthcare.gov.

The Health Insurance Marketplace is a virtual shopping mall of private insurers that are competing for your business. There are five available categories of plans, including platinum, gold, silver, bronze, and catastrophic, from several different types of insurers, offering cheaper, higher deductible plans to more expensive, comprehensive plans.

This coverage can begin as soon as January 1, 2014.

Below you’ll find helpful links to get you and your family started in researching and applying for the Health Insurance Marketplace plan that best fits your needs.

Step One: Get Ready to Enroll in the Marketplace

Before you enroll, you should take the time to learn about the types of health coverage that will be available, set a budget for your family and gather household income information. Click HERE to learn how to prepare.

Step Two: How to Choose Marketplace Insurance

Once you’ve gathered all the material and researched the process for enrolling, you’ll want to learn about the four categories of insurance that are available in the Marketplace: bronze, silver, gold, platinum. Click HERE to learn how to choose which Marketplace Insurance is best for you and your family.

Step Three: How to Apply for Marketplace Insurance

Now that you’ve prepared to enroll and chosen your preferred insurance, you can begin to apply. To apply, you’ll need to set up an account, fill out the online application, see what insurance you qualify for, and enroll. Click HERE to learn how to apply and when you’re ready to apply in Pennsylvania, click HERE.

Other additional information that you may need to know:

What is the Patient Protection and Affordable Care Act?

The Affordable Care Act (ACA) is a law that was signed by President Obama in 2010 that makes health insurance available to more Americans. Americans will receive their insurance through one of three primary ways: through their employer, through Medicare or Medicaid, or through the newly opened Health Insurance Marketplace. For those who are not exempt and who do not have insurance by January 1, 2014, a penalty will be assessed.

What is the Health Insurance Marketplace?

Health Insurance Marketplaces are essentially virtual shopping malls for those needing to purchase insurance. Through the Marketplace, individuals and families can easily compare different types of insurance and purchase the insurance that best fits their needs. States had two options for Marketplaces: either open their own Marketplace, or use a Marketplace provided by the federal government. Pennsylvania decided to utilize the federal Health Insurance Marketplace, which can be found at healthcare.gov.

Who will be shopping for insurance in the Health Insurance Marketplace?

Primarily, those who don’t receive health coverage through Medicare, Medicaid, or their employer will utilize the marketplace. Additionally, those who find their employer-provided insurance is too expensive may wish to utilize the marketplace.

Is healthcare.gov the only way to purchase insurance?

For those who prefer, there are options to purchase insurance over the phone or through the mail. A navigator can assist for those who do not wish to enroll online.

What if I need help enrolling?

In all states, there are trained and certified individuals to help you understand your options and help you enroll in a plan. These people are known as navigators. Visit https://localhelp.healthcare.gov/ to find help in your specific area.

What if I choose not to have health insurance in 2014?

Individuals may have to pay a fee if they do not have health insurance in 2014. Visit https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/ to learn about the fees for not having health insurance, what type of health insurance doesn’t qualify as coverage, and who may be exempt from having to pay the penalty.

Are there any groups of people who may be exempt from having insurance?

Yes, there are small groups of individuals who may qualify for an exemption. Some of those small groups of people include those who are uninsured for less than 3 months out of the year, those who would have to pay more than 8% of their household income for insurance, those who do not file a tax return due to low income, those who are members of a recognized religious sect with religious objections to insurance, those who are incarcerated, and more. For a full listing of those who may qualify for an exemption, please click here.

How much will the plans cost?

The actual prices of the plans depend on a number of factors including your age, number of people in your family, where you live, etc. However, many people will be eligible for tax credits provided by the government that will reduce the cost of insurance. For example, subsidies are available to people whose income falls between 100 and 400 percent below the federal poverty level. Below is a chart that may help determine if your income is within federal poverty limits for 2013:

 

Persons in Family

FPL

133%

250%

400%

1

$11,490

$15,282

$28,725

$45,960

2

$15,510

$20,628

$38,775

$62,040

3

$19,530

$25,975

$48,825

$78,120

4

$23,550

$31,322

$58,875

$94,200

5

$27,570

$36,668

$68,925

$110,280

The Kaiser Family Foundation has created a calculator to help families and individuals estimate the potential costs of health insurance. Use this link for more information.

What does the Marketplace Health Insurance cover?

Click https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/ for specific information on what’s covered. For questions about dental insurance through the marketplace, click https://www.healthcare.gov/can-i-get-dental-coverage-in-the-marketplace/.

What if I think I qualify for Medicaid or that my children qualify for CHIP?

If you qualify for Medicaid, you won’t need to buy a health insurance plan in the Marketplace. Click https://www.healthcare.gov/do-i-qualify-for-medicaid/ for specific information.

If your children qualify for CHIP, you won’t need to buy a health insurance plan in the Marketplace for them. Click https://www.healthcare.gov/are-my-children-eligible-for-chip/ for specific information.

What if I have a pre-existing condition?

In 2014, a health insurance plan cannot refuse to cover you or charge you more based on a pre-existing condition. Click https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/ for specific information.

If you currently have insurance through the federal Pre-existing Condition Insurance Plan (PCIP), you should know this plan ends December 31, and you must take action by December 15 to avoid a coverage gap. Click https://www.healthcare.gov/what-if-i-have-pcip-coverage/ for specific information.

What are my options if I’m unemployed, self-employed, or own a small business?

If you are unemployed, click https://www.healthcare.gov/what-are-my-health-coverage-options-if-im-unemployed/ for specific information.

If you are self employed, click https://www.healthcare.gov/what-if-im-self-employed/ for specific information.

If you own a small business, you’ll want to find out if you’re required to offer health insurance to your employees, and if so, what those options might be. Click https://www.healthcare.gov/small-businesses/ for all the information you’ll need.

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