Learn tips on how and when to purchase insurance from the Healthcare Marketplace.
[5 MIN READ]
Chances are good that you’ve heard about the Health Insurance Marketplace over the last several years. But how does it work, what is the deadline and how do you make your purchase decision?
It can be confusing to wade through the mountains of information about healthcare coverage and determine what’s best for you and your family. We’ve put together a list of tips and FAQs to address the ins and outs of buying your health coverage on the Health Insurance Marketplace.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace is also called the Health Insurance Exchange. It’s a resource that helps you:
- Compare the coverage and affordability of available insurance plans
- Determine your eligibility for tax credits and special programs like Medicaid or the Children’s Health Insurance Program (CHIP)
- Choose, purchase and enroll in a health insurance plan. Plans cover things like prescription drugs, doctor visits, urgent care, hospital visits, and more.
Some of the available policies are subsidized by the federal government. Your cost to purchase those plans is reduced if you meet the eligibility requirements, which are based on income and family size.
When do I purchase insurance for 2024?
Each year the Health Insurance Marketplace has an open enrollment period for eligible taxpayers. Open Enrollment for health plans runs from November 1, 2023 through January 15, 2024.
Once that timeframe is over, you can only enroll in or change your plan if you qualify for a Special Enrollment Period. Qualification is based on a number of factors including changes to your household, income, coverage or residence. For a complete list of qualifications, go to the screener page at Healthcare.gov.
How do I apply for coverage?
You can apply for coverage in several ways, including:
- Online
- By phone at 1-800-318-2596. TTY users can call 1-855-889-4325.
- Through an agent or broker
If you have additional questions, please visit our financial counseling page or call 833-880-3500 Monday to Friday, 7:30 a.m. to 5:30 p.m. PST to learn how to make an appointment with a financial counselor who can help answer your questions and enroll you in a marketplace plan.
Are the plans on the Health Insurance Marketplace all managed by the federal government?
There are marketplaces on both federal and state levels. The one you use depends on the state in which you live.
If you start the process to get coverage at Healthcare.gov, it’s easy to know which type marketplace to use. First, you’ll find a form that asks for your zip code. Once you’ve entered that information, you’ll be directed to the proper location—state or federal—to get started.
Who is eligible to buy insurance from the Health Insurance Marketplace?
To enroll in an insurance plan through the Health Insurance Marketplace you:
- Must live in the United States
- Must be a U.S. citizen, a U.S. national, or a lawfully present immigrant
- Cannot be incarcerated
- Cannot be on Medicare
- Cannot be currently enrolled in an employer-provided health plan
What does it cost to buy insurance from the Health Insurance Marketplace?
The cost of insurance on the Health Insurance Marketplace varies depending on your income and the size of your family if you’re getting group coverage. 4 out of 5 enrollees can find plans that cost less than $10 a month. You may qualify for a tax credit that lowers your monthly bill and offers reduced out-of-pocket costs on deductibles and copayments. Find out more about whether you qualify for additional savings with this tool at Healthcare.gov.
What type of plans are available?
The four main types of health insurance plans available on the Health Insurance Marketplace are: Platinum, Gold, Silver and Bronze. Cost and coverage vary according to the tier you choose.
For example, Bronze offers the lowest monthly premium but has the highest out-of-pocket costs if you become injured or ill. Platinum has the highest monthly cost but can be a good choice if you require frequent care since plans in this category offer lower deductibles and out-of-pocket costs. Find out more about the metal categories here.
“Catastrophic” health insurance plans have the lowest initial cost but they also have very high deductibles and out-of-pocket costs. They are a way to protect yourself in a worst-case scenario but will not provide much assistance with routine medical care. You must meet certain eligibility requirements to purchase a Catastrophic plan.
What if I lost Medicaid/CHIP? Can I enroll in a marketplace plan?
If your coverage ended recently because you didn’t send in your renewal form, complete it and send it back right away. You may be able to restart your coverage without a new application. If you aren’t sure if you lost Medicaid or CHIP, or believe you’re still eligible, contact your state to confirm. (View your state’s Medicaid office contact information.).Note: You can apply to Medicaid/CHIP any time, and there’s no limit to the number of times you can apply.
If you think you no longer are eligible for Medicaid or have already been notified that you are no longer eligible and have lost your coverage, make sure to submit a new or updated Marketplace application as soon as this happens to see if you qualify. Go here for more information.
Find a doctor
The team of experts at Providence understand the important role health insurance plays in making your healthcare accessible and affordable. Find a doctor covered by your plan in our provider directory. Or use one of the regional directories below:
This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
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