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. Due to Covid-19, a new Special Enrollment Period has opened up for Marketplace Plans (ACA Plans). During this time you may be able to sign up for a new plan if you are currently uninsured or switch plans. Usually, you must undergo a qualifying life event to qualify for a special enrollment period, but most states are opening the SEP up to everyone.
When is the Covid-19 SEP?
For most states, the special enrollment period will run from February 15-May 15 2021. There are some exceptions:
In these states, the dates are slightly different:
- Colorado: Feb 8th – May 15th
- Connecticut: Feb 16th – May 15th
- Massachusetts: Feb 15th – May 23rd
- Minnesota: Feb 16th – May 17th
- New York: Feb 15th – March 31st
- Vermont: February 16th – May 14th (phone only, not online)
Additionally, several states are only allowing uninsured people to enroll without a qualifying life change:
- Rhode Island
- Washington DC
Unfortunately, Idaho is not participating at all, so you’d need a qualifying life event to be eligible
Usually, you are able to enroll in Marketplace Insurance every year during the annual open enrollment period. For most states, the Open Enrollment Period is November 1st- December 15th. Coverage begins on January 1st.
One of the central conceits of the Affordable Care Act is that all health insurance plans must offer essential benefits. You can find a full list of essential benefits here.
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
- 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:
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. These are determined by the plan you choose. Things like:
- Chiropractic Services
- Physical Therapy
- And More!
If these benefits are important to you, you need to do your research when comparing plans. When you logon 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. We advise you to make decisions based on your central needs, not the fringe benefits offered by a given plan. There are many options available to you. For that reason, we recommend working with a third party to guide you.
How Much Does it Cost?
If you’ve had insurance through your employer in the past, insurance through the Marketplace may come with a bit of sticker shock. As 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. A plan may seem inexpensive at first, but if it doesn’t match your needs, it may end up costing you more in the long run.
There are tax credits available depending upon your income level. In order to qualify, your income must be between 100%-400% of the federal poverty guide for your household size. There are four possible brackets that your income may fall into. The first may prompt you to apply for Medicaid. The second will indicate that you are eligible for lower monthly premiums plus extra savings with silver plans. The third will state that you are eligible for a premium tax credit (lower monthly premium). The highest bracket means that you are ineligible for any type of savings. Many individuals fall on the cusp of eligibility for the premium tax credits.
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 MAGI (Modified 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. You can reach us here at iHealthBrokers at 888-918-0518 or schedule a call today.
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.