Health Insurance Marketplace Enrollment Guide

 

Whether you are in the research phase, figuring out more information about getting health insurance through the Marketplace, or if you’re seeking Marketplace health insurance enrollment information, you’ve come to the right place.

This post explores all there is to know about federally-sponsored healthcare through the Marketplace, including Marketplace health insurance plans (like Catastrophic coverage and other metal-named plans), Marketplace health insurance costs, and other healthcare mandates to be aware of. Read on to gain insight into the health insurance Marketplace.

How Does Marketplace Insurance Work?

Are you wondering, “How does Marketplace insurance work?”

Well, here’s the answer. With the Affordable Care Act of 2010, the U.S. federal government launched a health insurance marketplace where you can purchase individual or business health insurance plans.

To use the Marketplace, you should create an account on Healthcare.gov. Then from there, you can search and enroll in the right plan for you.

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Does a Healthcare Mandate Still Exist?

While previously there was a penalty incurred for lack of healthcare coverage, this is no longer the case in 2020/2021.

In fact, you are no longer subject to a penalty if you do not have health insurance of any kind, let alone plans through the federal Marketplace.

Tax reform from the Tax Cuts and Jobs Act (TCJA) eliminated the individual healthcare penalty. The removal of the penalty began with 2019 tax returns filed in 2020. Here are additional details about the ACA penalty.

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What is Hardship Exemption?

If you didn’t have health insurance this year, you may be avoiding your tax return in fear of having to pay a penalty. There’s good news. Because the healthcare penalty is was eliminated, hardship exemptions are no longer necessary to avoid paying any tax penalties for not having health insurance. Here’s a closer look at hardship exemptions.

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Marketplace Health Insurance Enrollment – Who Can Enroll?

While it’s not a government mandate to have health insurance, the Marketplace health insurance plans are still available for any American citizen, American natural, or individual considered lawfully present for purposes of using the Marketplace.

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When Can You Enroll?

The Open Enrollment Period for insurance on the federally facilitated Marketplace insurance typically runs from November 1 through December 15. State based Marketplaces may have varying open enrollment periods.

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How Much Does Marketplace Insurance Cost?

Marketplace insurance cost depends on the type of plan you choose, how many family members the plan covers, and your geographic location.

There are four health insurance categories to choose from with the Marketplace, plus Catastrophic health insurance coverage, which are listed below:

Bronze:

The cheapest health care options the Marketplace offers that are still eligible for a premium tax credit are the “Bronze” level plans. Bronze has the lowest monthly premium, but highest costs if you need care outside of what’s provided. Bronze plan deductibles can be thousands of dollars per year if a catastrophic (and unplanned) health event happens to you. Your monthly premium will be low, but you have to pay the most out of pocket for routine care.

Silver:

The Silver category has a moderate monthly premium, which means moderate cost of care.Silver deductibles are lower than Bronze plans, but that is because your monthly premium costs are higher. With a Silver plan, you will pay less out of pocket for routine care than the Bronze plan.

Gold:

The Gold plan has a high monthly premium, but low costs when you need health care. Its deductibles are low because you pay in more per month than the Bronze and Silver plans. The Gold plan is a good choice for those who know they will need a lot of care.

Platinum:

The platinum plan has the highest monthly premium and lowest cost out of pocket. Additionally, this plan tier’s deductible costs are low, due to high monthly premium costs. People may choose this plan when they know they need to receive a lot of healthcare per year and are willing to pay a high monthly premium cost.

Get more information on Marketplace health insurance categories.

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What About Catastrophic Coverage for Health Insurance?

Catastrophic coverage is the lowest cost per month. Many young people choose “catastrophic” coverage, which has cheaper monthly premium payments than a traditional plan but much higher deductibles, usually several thousand dollars. If, for instance, you have a bad car accident, you’ll be protected from major hospital costs once you pay your deductible.

Additionally, if you buy catastrophic coverage in the Marketplace, you’ll get three primary care visits per year as well as free preventative care for services like screenings and vaccinations.

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What are the Drawbacks of Catastrophic Health Insurance Coverage?

Catastrophic plans don’t allow you to claim a premium tax credit (PTC). A PTC is money the Marketplace gives your insurance company to help lower the monthly premium payments you must make for your health care plan.

Not everybody can get a catastrophic health plan on the Marketplace. To qualify, you must be under 30 years old or obtain a hardship exemption.

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Medicaid vs. Marketplace

You should also consider if you qualify for Medicaid, a government program that provides free or low cost health care to millions of Americans. Coverage varies from state to state. The Marketplace can also help determine if you’re Medicaid eligible if you fill out an application. If you are eligible for Medicaid, the Marketplace will help you get enrolled in Medicaid.

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How to Enroll for Marketplace Healthcare Insurance

There are a variety of ways to select the coverage you need and the federal marketplace tax credit you deserve. Here are the ways to enroll for Marketplace health insurance.

Online Registration

The online application is easily the most accessible method for reviewing coverage premiums and health coverage tax credit options available through the healthcare Marketplace.

The process begins by first determining if you hold coverage from the prior enrollment year or if you are accessing the marketplace for the first time. After verifying your marketplace status, you can easily navigate the application process.

Enrollment by Phone

If you do not have immediate internet access or prefer the advice of a healthcare.gov agent, you can call the Marketplace Call Center at 1-800-318-2596. The call center team is available 24 hours per day, 7 days per week with the exception of major federal holidays.

Before contacting the Marketplace Call Center team, it’s highly advisable that you take time to create a healthcare.gov account. There’s a handy checklist located here that can help to expedite the phone process. By proactively taking these steps, your over-the-phone enrollment process should ideally go as smoothly as possible.

In-person

Starting with a quick ZIP Code search, you can easily map local in-person assistance. There are two face-to-face resources offered in partnership with the HealthCare.gov Marketplace.

The first method involves meeting community-specific assisters who partner with local groups and community initiatives. This service is available free-of-charge and exists as a resource for individuals who need step-by-step guidance.

The second method involves employing the services of an insurance agent or broker. These licensed individuals can complete the enrollment process from initial sign-up to final purchase.

Via Mail

For those who prefer to file early, and time is not of the essence direct mail may be the best option. The printable version of the coverage application, found here, is also available within the Special Enrollment Period or SEP. The application and PDF instructions should be made available by or before November 1 of the calendar year.

The SEP is available “outside the yearly Open Enrollment Period” which extends access to health insurance enrollment to in certain circumstances to individuals.  You may have also heard of “qualifying life events.” Examples include marriage, birth or adoption of a child, loss of coverage altogether, or moving.

Your premium eligibility results, including your marketplace healthcare tax credit, should be communicated via direct mail within two weeks.

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How to Notify Marketplace of An Address Change

If you’ve moved or are planning to move in the next calendar year, make sure to notify the Marketplace of your change of address.

Reporting a change in address notifies the Marketplace of your new location. It also may qualify you for a special enrollment period, which would allow you to enroll in a new plan. The types of Marketplace plans available in your new area and the plan premiums will probably be different. In turn, the appropriate amount of advance payments of the premium tax credit that the government sends to your health insurer will likely change as well.

Reporting the changes in a timely manner will ensure that you’re enrolled in the right plan and help you get the right kind of assistance. For instance, getting too much premium healthcare assistance means you may owe additional money or get a smaller refund when you file your taxes. On the other hand, getting too little could mean missing out on monthly premium assistance that you deserve.

If you are receiving advance payments of the premium tax credit, it is particularly important that you report the new contact information.

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Other Life Changes You Should Report

In addition to an address change, let the Marketplace know about the following life changes:

  • A change in your income, including lump sum payments like a lump sum payment of Social Security benefits
  • A legal relationship change – like a divorce or marriage
  • The addition of a child – like the birth or adoption of a child
  • Starting a job with health insurance and any new eligibility to other healthcare coverage you may have

Many of these changes in circumstances – including moving out of the area served by your current Marketplace plan – qualify you for a special enrollment period to change or get insurance through the Marketplace.

In most cases, if you qualify for the special enrollment period, you will have 60 days to enroll following the change in circumstances.

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How Do You Report This Change?

You can report the change of address to the Marketplace online, via phone or in person. Follow the steps listed on Healthcare.gov.

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Where to Go for More Help with Marketplace Health Insurance Plans

View more details about the Marketplace – like eligibility, news, and resources – at HealthCare.gov.

And use the IRS Premium Tax Credit Change Estimator to estimate your premium tax credit.

For help navigating your taxes and the appropriate tax reporting for health insurance, learn about the ways to file with H&R Block.

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