Health insurance policies are available through a Marketplace available in every state since 2014.
All policies sold after 2014 cannot deny coverage, or charge more or refuse to cover treatments because of pre-existing health conditions.
Users can compare various private health insurance options all in one place.
Marketplace plans are broadly categorised into the following four ( 4 ) categories – Bronze, Silver, Gold and Platinum.
Starting with Bronze , the out of pocket costs get lower while the premiums get higher
When can a person buy coverage in the Marketplace?
You can shop for coverage and purchase or change Marketplace plans during the annual open enrollment period which occurs every fall. Once the open enrollment period ends, you must wait until the next open enrollment period to buy insurance in the Marketplace unless you qualify for a special enrollment period.
I am already enrolled in a plan I bought in the marketplace
You will get a notice from your current plan about renewal your coverage. The Open enrollment gives you the option to compare other plans available to you and make sure you are able to get all the financial assistance that you qualify for.
During this period, contact the Marketplace to make sure you are still getting the right amount of tax credit to buy a plan and see if you are enrolled in the best plan for you. Since health plans and prices change every year, you may find a new plan that is more affordable and also meets your needs. Every year, plans can change their drugs allowed (list of covered drugs) and/or network of health care providers so be sure to double check that your drugs and health care providers will still be covered and what it will cost you if you want to stay in the same plan.
In 2016, Marketplaces in most states will have online tools to help you see which doctors are covered in plans and whether a health plan covers a particular prescription drug. Visit www.healthcare.gov to search for plans available to you in your state’s Marketplace.
Is it necessary to have Health Insurance?
Since 2014 it is compulsory for most individuals to have health insurance or pay a tax penalty in the following year, unless they qualify for an exemption. Plans purchased in the Marketplace will meet this requirement, and so will job-based coverage, Medicare, Medicaid, state Children’s Health Insurance Programs (CHIP), most TRICARE plans and the Veterans health care program.
If you get insurance from another source make sure it meets minimum requirements to avoid the tax penalty.
What is covered in plans purchased from the Marketplace?
Health insurance plans sold in the Marketplace must at least cover a set of “essential health benefits” which includes: doctor’s office visits; emergency room services and hospitalization; pregnancy and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive services; chronic disease management; and children’s health services (including oral and vision care).
The specific benefits covered and the amount you pay will depend on the plan you have purchased.
It is important to check if the plan covers diabetes supplies, services, and prescription drugs that you need, and what it costs. Check all costs, such as the deductible and co-pays for doctor visits and each prescription drug you need. If you want to keep your current health care providers, check to see if they participate in the plan.
You can find this information in he “Summary of Benefits and Coverage” for the plan. You may also call the plan for questions about coverage for specific services and more details
I need more Information About the Plans Available to Me?
You can contact your state Health Insurance Marketplace. You can find contact information for the Marketplace in your state by visiting www.healthcare.gov or by calling 1-800-318-2596 (24 hours a day/7 days a week).