The health insurance marketplace can be a confusing maze of terminology and details. Have no fear, this article explains what the health insurance marketplace is, how it works, the eligibility requirements, and what types of plans are available. You’ll be able to find your way through with a clear understanding of your options so you can shop with confidence.
What is the individual Health Insurance Marketplace?
The Health Insurance Marketplace is a public, one-stop online “store” where you can shop for individual and family health insurance plans in your state.
Also known as the Exchange, it is a shopping portal that allows you to compare the prices, quality, and benefits of many health plans in one place. Every state either has its own public health insurance marketplace, like Minnesota’s MNsure, or they rely on HealthCare.gov to support their state’s public online shopping experience.
How does the health insurance marketplace work?
The health insurance marketplace is really designed to help people who don’t have coverage - like from their employer - find the best quality and affordable coverage. Because insurance companies compete for your business in the exchange, they help increase competition and ease comparison shopping using an "apples to apples" approach. This direct competition is intended to keep the cost of health insurance premiums down.
Is marketplace insurance the same as Obamacare?
The original health insurance marketplace started as the federal Health Insurance Marketplace - a website where individuals could shop for various health care plans available under the Affordable Care Act (ACA), often referred to in earlier years as Obamacare, beginning in 2010. Since that time, 14 states have developed their own individual health insurance exchanges, aka marketplaces. All medical insurance plans sold on the public marketplace must be ACA-compliant, meaning they must cover 10 essential health benefits for consumers.
Types of insurance plans that are available in the marketplace
There are four levels, the metal categories, of health plans that you can buy on the health insurance marketplace: Bronze, Silver, Gold and Platinum.
The four metal categories are arranged based on the costs of your health under the plan – premiums, copays, deductibles, and coinsurance. The categories are not based on the quality of the care. This helps simplify comparison shopping. As names imply, a Platinum Plan is the most expensive (highest premium) but covers the highest percentage (about 90%) of your medical bills. Whereas, a Bronze Plan is the cheapest but only covers about 60% of your medical bills.
You can purchase any plan from any of these categories during the yearly Individual Open Enrollment Period.
Who is eligible for Health Insurance Marketplace?
If you don't have health insurance coverage through your job or are self-employed, the Health Insurance Marketplace is where you should go for your health coverage.
Everyone who shops in the Marketplace must live in the United States and meet certain residency or citizenship requirements. If you are enrolled in a Medicare plan, you are not eligible to shop the Marketplace. People who are incarcerated are also not eligible.
Key Marketplace eligibility requirements include:
- You must live in the United States
- You must be a U.S. citizen or national (or be lawfully present)
- You can't be incarcerated
You also might be eligible for financial help to help you pay for health insurance. It is determined by your income level and the number of people in your household. Financial help can lower the cost of your monthly premium, the amount you pay when you get care, or both. You will be able to see if you qualify as part of the marketplace application process.
Getting help with health insurance
Not sure where to begin? At HealthPartners, we help people in Minnesota and Wisconsin find the right plan with the right coverage.
Whether it’s open enrollment time or you have a special enrollment period, we’re here to help make things simple. That way, you can choose a health insurance plan you’re confident in.