What Is the Health Insurance Marketplace?
- Not everyone gets health coverage through an employer. Find out how the Health Insurance Marketplace through the Affordable Care Act (Obamacare) provides options.
The Health Insurance Marketplace is a website that lets you browse available health insurance plans and apply for coverage.
It was created under the Affordable Care Act of 2010 (often referred to as Obamacare) to help make insurance available to people who didn't have options for employer-sponsored coverage. But it's not as simple as logging into a specific website whenever you have the urge to buy health insurance and completing an application.
Discover more about the Health Insurance Marketplace and how you can use it to enroll for benefits.
Federal Versus State Health Insurance Marketplaces
First, know that there isn't actually a single marketplace. The federal government does sponsor an online marketplace at HealthCare.gov.
A number of states also sponsor marketplaces. If you live in one of the following states or DC, then you must enroll in coverage via the state marketplace:
- District of Columbia
- New Mexico
- New York
- Rhode Island
When Can You Enroll in New Health Insurance Coverage?
You can use the marketplaces to find and enroll in new health insurance plans during appropriate enrollment periods. There are two main types of enrollment periods.
Open Enrollment Periods
Open enrollment periods are for everyone. Whether you have insurance, need new insurance for the coming year or don't have insurance and are interested in getting a plan, you can visit the marketplace in the open enrollment period to sign up for a plan.
The open enrollment period for the federal insurance marketplace typically runs from mid October to early or late December. During this time, you complete an eligibility application to find out what plans you can purchase.
Depending on your household income and some other factors, the marketplace may direct you to apply for coverage with either Medicare or Medicaid programs.
You can create an account at HealthCare.gov to be notified each year by email, phone or text when open enrollment is approaching and when the deadline for enrollment is close.
The state marketplaces may have slightly different open enrollment periods than the federal marketplace, so it's important to check with your state site each year to find out when you can enroll in a marketplace plan.
Special Enrollment Periods
Some changes in your life can qualify you for a special enrollment period. That means you can use a federal or state marketplace to enroll in insurance outside of the regular enrollment period.
Examples of qualifying life events include:
- Getting married
- Adding to your family via the birth of a baby, an adoption or foster care
- Getting divorced and losing your insurance because of it
- Someone on the plan you enrolled for passing away
- Moving to a new state
- Losing job-based coverage for almost any reason
- Losing your eligibility status for Medicaid, CHIP or Medicare
- Losing coverage through a family member
- Losing insurance coverage you purchased through the marketplace because the plan is going out of business or another reason that doesn't include simply not making your premium payments
How Much Are Marketplace Premiums?
The cost for health insurance through the marketplaces depends on a variety of factors, including the type of plan you choose, your household income and your age.
When you log in to the marketplaces to find out about health insurance coverage, you usually complete an informational form that allows the marketplace to verify your eligibility for coverage.
If you qualify for Medicaid coverage because of your income or other factors, you may be able to get coverage at no expense to you. In other cases, the marketplace shows you all policies available for you so that you can compare the benefits offered under each along with the costs.
Premium Tax Credits and Cost-Sharing Reductions
Depending on your income, you may qualify for reduced health care coverage costs. The first savings option is known as the premium tax credit. If your income falls under a certain threshold, you can qualify for a credit that reduces the cost of your premiums each month.
If you fall within the income range for cost-sharing reductions, then you can save on your actual medical expenses. Cost-sharing reductions lower your deductible and out-of-pocket maximum as well as coinsurance and co-payment amounts.
In most cases, you're notified if you qualify for these savings when you complete your application with the Health Insurance Marketplace.