What Is The Health Insurance Marketplace?

What Is The Health Insurance Marketplace?

The Health Insurance Marketplace is a like a central database of which your state government is the administrator. The state pools all the information from private corporations that offer health insurance to the general public.

Also called a health insurance exchange, this system allows you to see and compare side by side all the health insurance plans available to you. This is intended to give you a clearer picture of the options on offer so you can decide which is the best health insurance plan for you.

All of the plans offered must carry certain essential coverage. The health insurance companies, therefore, have to compete for your business based on price as well as coverage and services above and beyond the basics.

At a bare minimum, all health insurance plans must offer the following:

* Ambulatory patient services (outpatient care you get without being admitted to a hospital)
* Emergency services
* Hospitalization (such as surgery)
* Maternity and newborn care (care before and after your baby is born)
* Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
* Prescription drugs
* Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
* Laboratory services
* Preventive and wellness services and chronic disease management
* Pediatric services

In the past, health insurance companies would refuse to provide health coverage to individuals with pre-existing conditions, or would charge them exorbitant premiums. This problem has been eliminated in the Health Insurance Marketplace.

You cannot be turned away or be charged higher premiums because of a pre-existing condition in the Marketplace.

How Do You Participate In The Health Insurance Marketplace?

In order to buy health insurance in the Marketplace, you:

* must live in the United States;
* must be a U.S. citizen or national (or be lawfully present);
* must not be currently incarcerated.

To use the Health Insurance Marketplace, you provide some information about your family size and income and the system then provides a list of all the health insurance plans being offered to you by private health insurance companies.

You can provide the information and apply online here.

Or you can apply over the phone or in person. Find out more by scrolling down on this page.

Fees If You Don’t Participate In The Health Insurance Marketplace?

Once again, it is compulsory for everyone to have health insurance. Anyone found to not be covered will face a fee or penalty. This will be on top of the cost of a health insurance plan that will still have to be bought. Additionally, if a person needs medical care and does not have health insurance, the costs could lead to bankruptcy.

In 2014, the penalty is $95 per adult and half that for every child under 18, or 1% of household income, whichever is higher.

This cost goes up in 2015, to $325 per adult, or 2% of household income. It gets steeper in in 2016: ringing in at $695 per adult, or 2.5% of household income. The fee plateaus at the 2016 level and will be adjusted for inflation, thereafter that.

The sum will be assessed by the IRS, which will withhold amounts owing from any refund that might be due.

How Can You Get Low Cost and Free Health Insurance?