Health Insurance Marketplace Plans – 5 Things to Know

Woman holding a health insurance marketplace plan insurance checklist.

The Health Insurance Marketplace Plans are made available to Americans as part of the Affordable Care Act (ACA or Obamacare) established in 2010. Most Americans who need coverage can enroll for their health insurance via the Marketplace.

To help you understand how the health insurance marketplace plans work, who can help you sign up, when you can sign up, and more, we answer 5 of the most common questions about health insurance marketplace plans here:

1. Who Should Sign Up for Health Insurance Marketplace Plans?

Individuals who are unemployed, self-employed, or do not have health coverage through their employer, can purchase a health insurance plan on the Health Insurance Marketplace (also known as The Healthcare Exchange).

For children or disabled adults, the Children’s Health Insurance Program, Medicaid, or Medicare are alternative options.  For those who do not qualify for these government funded programs, the Health Insurance Marketplace Plans also offer some affordable alternatives.

2. Who Can Help You Get a Marketplace Plan?

Most people find it difficult to choose from among the hundreds of Health Insurance Marketplace Plans available. Additionally, it can be confusing to navigate the tax credits and understand how they are applied. The possibility of over-paying, or of having to pay back credits at the end of the year is real. The best way to know which health insurance marketplace plan is best for you, and to make sure any tax credits are used correctly, is to talk to an insurance agent.

3. When Can You Get Coverage Under Marketplace Health Insurance Plans?

For coverage in 2021, the enrollment period was from Nov. 1 through Dec. 15, 2020. If you have missed the deadline, or find yourself without health insurance mid-year, there are certain criteria which may allow you to enroll during a special enrollment period. To see if you can qualify for a special enrollment period, and for help in choosing health insurance marketplace plans, it is best to consult with an agent.

If you have a qualifying event (sudden change in your life circumstances) you may be eligible for early sign-up (outside the enrollment period). The qualifying event that leads to loss of existing health coverage may include having a baby, adopting a child, getting divorced or married, change in income, or moving to a different county.

Outside of a qualifying event, most individuals will need to shop around and purchase an insurance plan during the 6-week enrollment period (Nov 1, 2020-Dec 15, 2020)

4. What are Some Rules & Basics for Insurance Coverage under the Marketplace Plans?

Some of the key benefits of the Affordable Care Act to Marketplace Health Insurance plans include the following:

  1. The individual cannot be denied coverage and/or charged more money in the presence of a pre-existing condition
  2. The other benefit is the introduction of 100% preventive care which includes regular checkups and a wide range of screening tests
  3. The third benefit is that every plan on the Marketplace must ensure coverage of essential health services which include: 
  • Ambulatory & outpatient services
  • Breastfeeding coverage
  • Chronic disease management
  • Newborn and children’s healthcare that also includes vision and dental care
  • Emergency medical treatment
  • Family planning 
  • Hospital admissions
  • Laboratory services
  • Mental health disorders
  • Paternity, maternity, and newborn care
  • Physical and occupational therapy
  • Most prescription medications
  • Preventive and wellness services
  • Substance use disorders

Preventive Services Most Health Insurance Marketplace Plans Cover 

The majority of Health Insurance Marketplace Plans will pay for the following screening tests:

  • Alcohol misuse counseling and screening
  • Blood pressure evaluation
  • Colorectal cancer screening
  • Depression screening
  • HIV screening
  • Immunization vaccines including the flu vaccine
  • Lipid levels (cholesterol)
  • Mammograms
  • Nutrition counseling
  • Type 2 diabetes screen
  • Weight (obesity) screening

5. How does Marketplace Health Insurance work?

You can go to www.healthcare.gov or your state’s own marketplace website, where you will be able to see and compare the different health plans available.

There are four METAL tiers of health insurance namely- Bronze, Silver, Gold, and Platinum. The bronze plans are the most affordable, offer the lowest amount of coverage but come with the highest deductibles and copayments. But if you are healthy with no major illness, then this may be the plan for you. The platinum plans are the most expensive and they offer all types of medical coverage, some of which you may or may not need.

When enrolling in any of Health Insurance Marketplace Plans, you will find out if you are eligible for the Cost Sharing Reduction or the Advanced Premium Tax Credit. If you are eligible, you will save additional money on health insurance. To be eligible for these savings, you must purchase your insurance plan through the Marketplace.

Insurers Offering Health Plans on Marketplace

The different types of Health Insurance plans are offered by private insurers like Cigna, Blue Cross, and United Healthcare. All these insurers offer the four METAL tier levels of health insurance. However, even between the same metallic level, several coverage choices that can affect your premium, and out-of-pocket coinsurance, deductibles, and copayments. 

Florida Insurance Companies often offer the same health insurance marketplace plans for purchase privately. Approximately one-third of the plans available to Floridians on the Federally Funded Exchange (Health Insurance Marketplace Plans), are also offered for sale directly by the insurer. 

Navigating the Health Insurance Marketplace Plans for Floridians.

Tens of Thousands of people have relocated to Central Florida in recent years.  If you are new to Florida and you moved from a state like California, Colorado, New York or Minnesota, you may be expecting to sign up for a Health Insurance Marketplace Plan on a state sponsored website.  While 13 states do offer healthcare marketplace access at the state level, Florida is not one of them.

There are plans available specifically for Floridians on the National Health Insurance Marketplace, and all are offered by major insurance companies.  The marketplace can be tricky to navigate, so it is always a good idea to consult with a Licensed Florida Insurance Broker to make sure you get the help you need in selecting the plan that is right for you.

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