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Marketplace Insurance: Insurance with the ACA

If you are currently self-employed or unemployed, you may be interested in pursuing a plan through the Marketplace.  You can find excellent coverage, but it can be overwhelming.  With so many options available, it’s imperative that you understand exactly what you are signing up for!  Marketplace insurance is part of the Affordable Care Act (ACA) sometimes known as Obamacare.  It was designed as a way to offer comprehensive health care at affordable rates.  Marketplace insurance is a great way to purchase coverage if you are self-employed or unemployed. 

Essential Benefits of the ACA

One of the central conceits of the Affordable Care Act is that all health insurance plans must offer essential benefits.  The ACA defines these essential benefits as:

  • Emergency services
  • Outpatient Care
  • Hospitalization 
  • Pregnancy, maternity, and newborn care (prenatal and postpartum)
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices 
  • Laboratory services
  • Preventive and wellness services (and chronic disease management)
  • Pediatric services

Additionally, all plans must offer birth control coverage and breastfeeding coverage.  That is not to say that these essential services come without a cost.  However, some services are guaranteed without any out-of-pocket cost. Services such as:

  • Preventative Care
  • Screenings
  • Vaccinations
  • Prenatal Care

Again, for these services, there is no copay or coinsurance.  For a full list of no-cost services, please visit healthcare.gov.   The additional essential benefits are guaranteed to be covered, but there may be a copay or coinsurance.  This is determined by the plan that you pick and the state that you live in.  

Marketplace Optional Benefits

Some plans offer more robust coverage than others.  There is a wide list of additional benefits and these are determined by the plan you choose.  Things like:

  • Vision
  • Dental
  • Chiropractics
  • Physical Therapy
  • And More!

If these benefits are important to you, you need to do your research when comparing plans.  When you log on to healthcare.gov, you will eventually be taken to a screen where you can compare plans.  You can apply a filter to weed out the plans that don’t offer your preferred benefits.  Of course, a plan that offers more benefits will usually be more expensive.  You may be better served purchasing a separate plan for something like dental or vision coverage.  There are many options available to you and for that reason, we recommend working with a third party to guide you.  

When to Enroll Through the Marketplace

You are able to enroll in Marketplace Insurance every year during the annual open enrollment period.  The Open Enrollment Period is November 1st- December 15th.  Coverage begins on January 1st.  You may also qualify for a Special Enrollment Period if you’ve undergone certain life events.  Qualifying events are:

  • Losing Health Coverage
  • Moving
  • Marriage
  • Having a Baby
  • Adopting a Child

Dependent upon your Special Enrollment Period type, you may have 60 days before or 60 days after the event to enroll in a plan. If you miss your Special Enrollment Period window, you may have to wait until the next Open Enrollment Period to apply.

How to Enroll:

There are multiple ways in which you can enroll.  You can:

  • Use an Agent
  • Use a Broker
  • Call Healthcare.gov
  • Use the Healthchare.gov website

First, you may call an agent.  An agent is a representative of a particular carrier (insurance company).  An agent will only present you with their company’s available plan.  You will not receive any type of special discount or avoid fees by working directly with an agent. 

You may also call a broker.  A broker works for you, not the insurance company.  They will help you compare multiple plans offered by multiple carriers.  You will not be charged any type of additional fee by working with a broker.  This is why working with a broker is our number one recommendation.  If you’d like assistance, you can reach us at iHealthBrokers at 888-918-0518.  

How Much Does Insurance Through the Marketplace Cost?

If you’ve had insurance through your employer in the past, insurance through the Marketplace may come with a bit of sticker shockAs with any insurance plan, there are monthly premiums, out-of-pocket deductibles to meet, and copays or coinsurance.  It’s important to have a good idea of exactly what your needs are upfront so that you can pick a plan accordingly.  Choosing the right plan is one way of saving money in the Marketplace.  

Additionally, there are tax credits available dependent upon your income level.  In order to qualify, your income must be between 100%-400% of the federal poverty guidelines for your household size.  You may be able to lower your taxable income by contributing to a Health Savings Account (HSA).  These are only available with High Deductible Health Plans (HDHP). You can also contribute a portion of your income to a 401K or IRA if available.  To learn how to lower your AGI (Adjusted Gross Income), you may want to speak with an accountant or financial advisor.  Healthcare.gov will ask you to estimate your income for the upcoming year and will price your plans accordingly.  Should you make more than your estimate, you may be required to pay these tax credits back when you file.    

Finally, the easiest way to save money on your health insurance is to work with a licensed broker.  They will listen to your needs and find you the best possible plan at the lowest possible rate. If you have any questions or concerns, please feel free to give us a call at (888) 918-0518 or schedule a call today. 

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Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.

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