What is this Health Insurance Marketplace?

Will the Health Insurance Marketplace be open to everyone?

As reported by Kaiser Health News, as far as the foreseeable future is concerned, the answer to this question is no. Kaiser reports: “Initially, exchanges will be open to individuals buying their own coverage and employees of firms with 100 or fewer workers (50 or fewer in some states). Most Americans will continue to get insurance through their jobs, not via the exchanges. Most will be people who are eligible for subsidies, which will average an estimated $4,600 per person in 2014. Undocumented immigrants will be barred from buying insurance on the exchanges.”

Along with American Health Benefit Exchanges—the type of exchanges described thus far—the ACA has also established Small Business Health Options Program (SHOP) Exchanges, which will allow small employers with up to 100 employees to purchase coverage in the Health Insurance Marketplace. The US Small Business Administration is an excellent source of information about the Affordable Care Act particularly as it relates to small businesses.

As the American Medical Association (AMA) reports, the primary beneficiaries of Health Exchanges are intended to be small businesses and US citizens and legal immigrants who do not have access to affordable coverage offered by their employers.

How can individuals prepare for the transition to the Health Insurance Marketplace?

To help potential enrollees get ready for changes the Health Insurance Marketplace will bring, Healthcare.gov offers a convenient list of these 7 things you can do to get ready now:

  • Learn about different types of health insurance

If you’re knowledgeable about your options, when the time comes to make a choice about coverage, you should be able to choose a health plan giving you “the right balance of costs and coverage.”

  • Make a list of questions you have before it’s time to choose your health plan.

That way, you can eliminate a lot of uncertainty and be in a better position to make the best possible choice.

  • Make sure you understand how insurance works, including deductibles, out-of-pocket maximums, copayments, etc.

By starting to investigate insurance options and asking questions now, you can eliminate a lot of surprises you don’t want.

  • Start gathering basic information about your household income

Healthcare.gov advises, “Most people will qualify to get a break on costs, and you’ll need income information to find out how much you’re eligible for.”

  • Set your budget

As simple as this sounds, many people fail to do it. Healthcare.gov advises,There will be different types of health plans to meet a variety of needs and budgets, and breaking them down by cost can help narrow your choices.”

  • Find out from your employer whether they plan to offer health insurance, especially if you work for a small business

Remember, businesses with 50 or fewer employees won’t generally be required to provide insurance, so you should not assume that a small business will insure all its employees. And remember that the Health Exchanges are largely for employees whose companies will not provide insurance.

  • Explore current options

Advising that “you may be able to get help with insurance now, through existing programs or changes that are in effect already from the new health care law,” Healthcare.gov offers a resource page to help you find information about current healthcare options including Medicare.   

One thought on “What is this Health Insurance Marketplace?

  1. Under the Affordable Care Act, all Americans will be able to get health insurance regardless of income or health history. By October 2013, each state will have its own Health Insurance Marketplace with plans that offer comprehensive coverage.

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