Understanding The Health Insurance Marketplace & Ways to Lower Your Cost

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You are looking for a good health insurance plan that is both affordable and advantageous. However, too many insurance providers and options are available, some of which may seem comparable but have varying prices. What is the reason?

The Health Insurance Marketplace has drawn a large number of visitors looking for assistance in this case. This Marketplace allows you to compare one option against hundreds of other healthcare plans. They also recommend a wide choice of healthcare programs, at least one of which will satisfy your needs.

 

What Is the Health Insurance Marketplace?

The Health Insurance Marketplace offers insurance policies to individuals and small businesses. This platform helps people search for and enroll in health insurance that meets their requirements and financial condition.

Each health policy in the Marketplace covers the same core health services, including doctor visits, preventative care, hospitalization, prescriptions, and more. Thanks to this platform, you can evaluate plans based on their rates, advantages, quality, and other relevant aspects. As a result, you can consider what benefits you the best and make the most of your budget.

 

Who Is Eligible to the Health Insurance Marketplace?

The Health Insurance Marketplace has specific criteria for individuals or families who want to sign up for insurance policies. To access the Health Insurance Marketplace, you must:

  • Be living in the United States.
  • Be an American citizen or national
  • Not be incarcerated

 

You can join the Marketplace regardless of the state where you reside. Several states run their own markets. The federal government also runs an exchange accessible to citizens of other states.

You can purchase a plan in the Marketplace if you don’t already have coverage from work, Medicare, Medicaid, the Children’s Health Insurance Program, or another source.

 

How Does the Insurance Marketplace Work?

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You must provide your income and household details when you apply for individual and family insurance policies through the Health Insurance Marketplace.

People not eligible for employer-sponsored insurance can locate a suitable plan through the Marketplace, which promotes competition among private insurers in one convenient location. During the open enrollment, people can use the Marketplace to compare programs and submit applications. This time frame often falls in November and December of the year.

Once the Open Enrollment Period ends, you can only sign up for a Special Enrollment Period or change your health plan. To do so, you must be qualified for the following prerequisites within the past 60 days:

  • Got married
  • Had a baby, adopted a child, or placed a child in foster care
  • Got divorced or officially separated
  • Lost your health insurance coverage
  • Moved to a different ZIP code or county
  • Had a change in income that affects your insurance policy
  • Died

 

Requirements for Marketplace Plans

Regardless of your income, marketplace plans guarantee that you will receive a specified basic level of healthcare. Additionally, you have rights as a customer of the Marketplace.

All plans available on the Marketplace must cover the following essential health benefits:

  • Preventive care
  • Patient ambulatory services
  • Breastfeeding care
  • Services for infants and children (dental and vision care included)
  • Emergency services
  • Family planning
  • Medical services (including prescription medications and hospitalization)
  • Laboratory services
  • Services for mental health
  • Services for physical and occupational therapy
  • Coverage for pregnancy, maternity, and infant child care services

 

How to Get Started in the Marketplace

First, visit HealthCare.gov or the equivalent website in your state. You will then receive a brief side-by-side comparison of the offered plans.

You can select from the health insurance tiers in the database, including:

  • Bronze
  • Silver
  • Gold
  • Platinum

 

Bronze plans offer the least costly monthly premium. However, their deductibles, coinsurance, and copayments are the highest. Meanwhile, the most expensive monthly payments are platinum programs.

It might be challenging to determine since each plan offers distinct benefits and drawbacks. Therefore, you should take time and learn about the various plans’ advantages to help you decide which suits you best.

 

Health Plans Comparison

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You can choose from private health insurance providers on the Marketplace. Where you live affects the mixture you receive.

The four levels mentioned above are divided into each company’s healthcare plans. The levels show an approximate percentage of costs that the plan will cover:

  • Bronze, the plan pays 60%, you pay 40%
  • Silver, the plan pays 70%, you pay 30%
  • Gold, the plan pays 80%, you pay 20%
  • Platinum, the plan pays 90%, you pay 10%

 

You can select from various coverage options, even when purchasing at the same metallic level. Your choice will impact your premiums and out-of-pocket expenses for deductibles, copayments, and coinsurance. Remarkably, plans from one provider may cost more or less than the same plans offered by another company.

 

How to Lower the Costs of Marketplace Health Insurance

Cost-Sharing Reductions

Cost-sharing reductions are discounts that are exclusively accessible with Silver plans. This discount helps lower your out-of-pocket expenses for:

 

Only the following individuals are eligible for cost-sharing reductions:

  • Those who are ineligible for Medicaid or the Children’s Health Insurance Program
  • Those who can obtain suitable health insurance through their employer
  • Those with salaries between 100% and 25% of the federal poverty level

 

Advanced Premium Tax Credit

When people buy health plans through the Health Insurance Marketplace, they can receive a federal tax credit called the advanced premium tax credit that lowers the monthly rates. You can select any metallic level plan in the Marketplace using this credit.

The advance premium tax credit is available for:

  • Those who are not entitled to receive public coverage.
  • Those who can’t get qualified health insurance through their employer.
  • Those with income between 100% and 400% of the federal poverty level.

 

Your health insurance receives premium tax credits directly from the government, cutting your monthly payment. You have the right to select the amount of credit to apply to the monthly premium if you are eligible.

The premium tax credits you got and the actual amount you are eligible for will be adjusted when you complete your yearly tax return. When you file your return, you might need to pay the money back if you received more payments than you were entitled to.

 

Select Catastrophic Coverage

Catastrophic policies are one of the available alternatives.

A catastrophic health plan covers three annual primary care visits before reaching the deductible. Additionally, it offers free preventative services. Although the monthly premium is significantly cheaper than other plans, deductibles, copayments, and coinsurance expenses are substantially higher.

However, remember that you won’t be qualified for cost-sharing reductions or premium tax credits if you qualify for a catastrophic plan.

 

If you have any questions about the Health Insurance Marketplace, please get in touch with us to receive a free consultation. 

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