What is a Health Insurance Marketplace?
When key parts of the Affordable Health Care law take effect in 2014, there’ll be a new way to get health insurance – the Health Insurance Marketplace. The Marketplace is designed to help you find health insurance to fit your budget.
Every health insurance option in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on
- quality, and
- other features that may be important to you.
Insurance coverage run by private companies
When you shop at the Marketplace, coverage information will be laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you pay and what coverage you receive before you make a choice.
Under the health care law, there will also be new protections for you and your family. Health insurance companies can't refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.
Many people will get a break on costs
Working families will be able to get help through the Health Insurance Marketplace. There will be new, expanded programs available, and more people will qualify for free or low-cost health insurance programs.
ADVANCE PREMIUM TAX CREDITS ARE ONLY AVAILABLE WHEN APPLYING ON THE FEDERAL MARKETPLACE AND WHEN HOUSEHOLD INCOME IS BETWEEN 100% TO 400% OF THE FEDERAL POVERTY LEVEL (FPL). FOR COST SHARING REDUCTIONS (REDUCED DEDUCTIBLES AND CO-PAYMENTS) YOU MUST HAVE A SILVER PLAN AND UNDER 250%.
FAMILY SIZE (FPL) 100% 250% 400%
1 $11,880 $29,700 $47,520
2 16,020 40,050 64,080
3 20,160 50,400 80,640
4 24,300 60,750 97,200
5 28,400 71,100 113,760
6 32,580 81,450 130,320
Even if you think your income is too high to get help you might still get a break on costs through the Marketplace. Coverage falls into four categories based on how you and the policy expect to share the costs of care:
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your out-of-pocket costs —the total amount you’ll spend for the year if you need care.
The Marketplace also offers "catastrophic" policies to people under 30 years old and to some people with very low incomes.
Balancing monthly premiums with out-of-pocket costs
As with all health coverage, you will still have to pay a monthly premium.
- Premiums are usually higher for policies that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold policy, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
- With a Bronze policy, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
- Platinum policy will likely have the highest monthly premiums and lowest out-of-pocket costs.
The policy will pay more of the costs if you need a lot of medical care.
In general, when choosing your health coverage, keep this in mind:
- the lower the premium, the higher the out-of-pocket costs when you need care;
- the higher the premium, the lower the out-of-pocket costs when you need care.