What is the Healthcare Marketplace?
The healthcare marketplace is a service that helps people shop for and enroll in health insurance. The federal government operates the Health Insurance Marketplace, available at www.HealthCare.gov, for most states. Some states run their own Marketplaces.
The Health Insurance Marketplace (also known as the “Marketplace” or “exchange”) provides health plan shopping and enrollment services through websites, call centers, and in-person help.
When you apply for individual and family coverage through the Health Insurance Marketplace, you’ll provide income and household information. You’ll find out if you qualify for:
- Premium tax credits and other savings that make insurance more affordable
- Coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state
On HealthCare.gov, you may be asked to select your state or enter your ZIP code. If you live in a state that runs its own Marketplace, we’ll send you to your state’s Marketplace website.
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Who Shops on the Marketplace?
Any American citizen or national is eligible for health insurance. Whether you’re applying as an individual or for your family, you’ll need to provide income and household information to see which plans you qualify for on www.healthcare.gov.
If you and your family don’t have health insurance coverage through your job, you can choose a health plan from the Marketplace and pay for it on your own. If you are self-employed or unemployed, the Marketplace is a place to go for health coverage.
If your employer offers health insurance coverage, you can still shop the Marketplace, but you will pay full price for your plan. Everyone who shops the health insurance Marketplace must be a U.S. citizen and live in the United States. If you qualify for Medicare, you are not eligible to shop the Marketplace. People who are incarcerated are also not eligible.
Essential Health Benefits
All plans offered in the Marketplace cover these 10 essential health benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency Services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder treatments, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
When Can I Buy a Plan on the Marketplace?
You can shop for health insurance during Open Enrollment or a Special Enrollment Period . The Open Enrollment period starts each year on November 1, and ends December 15.
How Does the Marketplace Work?
To be eligible to enroll in health coverage through the Marketplace, you:
- Must live in the United States.
- Must be a U.S. citizen or national (or be lawfully present).
- Can’t be incarcerated.
If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.
The Marketplace works by giving you a myriad of health plan options based on your income, health status, home situation, age, and other factors. There are specific enrollment periods you need to follow, and it is the best option to use when applying for health insurance.
What Kind of Health Insurance Plans Are Available?
There are four levels of health plans that you can buy on the Marketplace: Bronze, Silver, Gold, and Platinum. (“Catastrophic” plans may be available to some people.) Each level pays a different portion of your health care bills.
You will also pay a portion of your health care expenses through your monthly premium, copays, deductibles, and coinsurance. The amount you pay depends on your plan.
The right plan to choose will depend on many factors, which vary from one person to another.
Comparing Health Plans
Compare your health plan options by visiting www.healthcare.gov, entering in your information, and seeing what is available to you. Choose the best plan to suit your needs and budget.
Understanding Out-of-Pocket Costs
Healthcare costs that aren’t covered by insurance, and that you pay for with your own money are called “out-of-pocket” expenses. Some out-of-pocket expenses not covered by health insurance plans include things like eye exams and dental care.
How Much Will Your Plan Cost?
The cost of your plan entirely depends on your location, age, family status, health history, and many other factors. You will have to compare plans to find out which cost is the best option for you. Across all metal tiers, the average cost of health insurance in the United States in 2022 is $541.
Where to Apply for Health Coverage
You can apply to and compare plans on the federal marketplace, at www.healthcare.gov. This can also depend on which state you reside in, as some states have their own independent marketplaces.
Benefits of the Health Insurance Marketplace
The Health Insurance Marketplace helps you find health coverage that fits your needs and budget. Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more.
Your Health Insurance Options
Go to www.healthcare.gov to view your health insurance options and plans that will suit your needs.
FAQ
Can I Buy a Plan in the Marketplace If I Don’t Have a Green Card?
If you are not a US citizen or not a lawfully present individual in the US, you are not eligible to buy a health insurance plan from the Marketplace.
How Long After I Enroll in a Plan Will Coverage Take Effect?
In most cases, your effective date isn’t immediate. In fact, depending on when you sign up for health insurance, your effective date could be more than a month away. The day your health insurance goes into effect depends on which half of the month you buy your plan.
Based on enrollment dates, your plan will typically begin to take effect on January 1st.
When Can I Enroll in Medicaid Through the Marketplace?
You can apply for Medicaid any time of year — Medicaid and CHIP do not have Open Enrollment Periods.
Do I Have to Prove Eligibility for a Special Enrollment Period?
Yes, in most states you do need to prove eligibility to apply for a special enrollment period. The federal Marketplace (HealthCare.gov) requires people to provide documentation of eligibility for special enrollment before you can enroll in coverage.
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