The health insurance marketplace has made coverage more accessible to millions of people. However, if you’re brand new to shopping for your own health insurance, it can be easy to get confused fast. There are plenty of terms to learn and details to know. You want to get coverage that’s best for both your health and your wallet, but how can you be sure you’ve made the right choice for both?
Well, have no fear. Consider us your guide as we give you a bit of background to what the health insurance marketplace is and how it may look in your state. We’ll dive into how the marketplace works and how plans are organized. Finally, you can see if you’re eligible for the marketplace and find out how HealthPartners can help you even more.
With our help, you’ll have the context, knowledge and understanding you need to shop with confidence!
What is the individual health insurance marketplace?
Also known as the health insurance exchange, the marketplace is a public, online “store” where you can shop for both individual and family health insurance plans in your state.
Through this shopping portal, you can compare the prices, quality and benefits of many health plans in one place. Plus, it’s a true marketplace, with many different insurers offering one or more plans to fit different needs and budgets.
The look and feel of your health insurance marketplace depends on the state where you live. Some states have their own marketplace, like Minnesota’s MNsure. Other states use the federal marketplace at HealthCare.gov
You can purchase any plan in the marketplace during the yearly Individual Open Enrollment Period.
Is marketplace insurance the same as Obamacare?
Yes – signed into law in 2010, the Affordable Care Act (or ACA) paved the way for the creation of a federal health insurance marketplace. (President Barack Obama signed the act into law, hence its early nickname of Obamacare).
In the years since, 14 states (including Minnesota) have developed their own individual health insurance exchanges, also known as marketplaces. And whether they’re sold on a state-specific exchange or on the federal marketplace, all medical insurance plans must be ACA-compliant, meaning they must cover 10 essential health benefits for plan members.
Types of insurance plans that are available in the marketplace
The health insurance marketplace works by classifying plans into four different metal levels: Bronze, Silver, Gold and Platinum.
These metal levels are organized by the costs of each plan, like premiums, copays, deductibles, and coinsurance. A plan in the Platinum level will have the highest premium. While they cost more than other plans on the marketplace, these Platinum plans will cover the highest percentage of your medical bills (around 90%).
This proportion of cost-to-coverage changes the further down you go from Platinum to Bronze. Bronze plans end up having the lowest premiums while only covering around 60% of your medical bills. The key is to find the right balance of cost to coverage that makes sense for both the amount of care you need and how much you’re willing to spend.
However, there’s one thing to keep in mind as you shop for plans. These levels are for the costs of each plan, NOT the quality of care you’ll receive. Buying a plan in a higher metal level doesn’t mean you’ll receive better care as a result.
Financial help through the marketplace
You might be eligible for financial help to pay for your health insurance. The amount of help you get is determined by how much you make each year and how many people are in your household. This can help lower the cost of your monthly premium, the amount you pay to get care or both. During the application process on the health insurance marketplace, you’ll get more details on financial help that might be available to you.
Who is eligible for Health Insurance Marketplace?
There are only a few (but important) requirements to be able to shop in the marketplace:
- You must live in the United States
- You must be a U.S. citizen, U.S. national or considered lawfully present
- You can’t be incarcerated (serving time in jail or prison)
- You can’t be currently enrolled in Medicare
If you pass all four, you’re OK to shop and enroll. But, when it comes to whether the health insurance marketplace is right for what you need, that’s a different question.
Should I use the health insurance marketplace?
It depends. First, if you’re currently employed, ask yourself if the plans that are offered by your work are both affordable and meet your current health needs. If so, it’s likely easier to stick with the options provided by your workplace. If not, it’s definitely worth checking out what the marketplace has to offer.
Second, if you’re unemployed or disabled, the marketplace is an excellent option if you can’t find an affordable plan and are not eligible for a state program like Medicaid.
Third, if you’re self-employed, the health insurance marketplace is definitely the right place for you – especially since you’ll have many competitive options from several insurers all in one place.
Have more questions about your health insurance options?
Our experts will help you find a health plan you’re confident in – no matter your situation.