One of the main features of US healthcare reform is the Health Insurance Marketplaces, where you can search for a health plan in your state if you don't have insurance. Below are some commonly asked questions and answers about this topic. You can also watch a video or read a brochure to learn more.
A Health Insurance Marketplace, or Exchange, is a one-stop shop that allows you to compare and enroll in health insurance plans. Every state has a Marketplace. It may be run by the state, by the federal government, or jointly by both. The Marketplaces mostly serve people and families buying insurance on their own.
There is an open enrollment period every year. When the
open enrollment period has closed, you may still be
eligible to purchase coverage through the Health
Insurance Marketplace if you have a qualifying life
event, such as marriage, having or adopting a child,
moving outside of your insurer's area, or losing other
To learn more, visit www.healthcare.gov or call 1-800-318-2596.
Plans must offer Essential Health Benefits. These include:
- Ambulatory services
- Emergency services
- Maternity and newborn care
- Prescription drugs
- Rehabilitative/habilitative services and devices
- Lab services
- Mental health and substance use disorder services, including behavioral health treatment
- Preventive/wellness services and chronic disease management
- Pediatric services, including oral and vision care
Coverage and co-pays vary by plan.
Plans are divided into 5 levels: bronze, silver, gold, platinum, and catastrophic. All plans offer the 10 categories of Essential Health Benefits. What differs is the amount of coverage provided and the cost of premiums and out-of-pocket costs for services. Which medicines are covered and the portion you pay will also vary. The silver plan is the only plan that helps people who have low incomes with cost-sharing. Find out more at www.healthcare.gov/choose-a-plan.
A pre-existing condition is a condition you have prior to joining a health plan. Most insurance plans cannot deny coverage for a pre-existing condition. And they can't charge more for treating it. For more information, go to www.healthcare.gov/coverage/pre-existing-conditions
The Individual Mandate requires you to get health insurance that meets minimum standards, or pay a penalty. The Individual Mandate does not apply to:
- Those incarcerated
- Members of Native American tribes
- Those not lawfully present in the US
- People meeting specific income levels
The ACA calls for the expansion of Medicaid eligibility to all people with incomes up to 138% of the federal poverty level. This is to make coverage more available and consistent from state to state. It is up to each state to decide whether to expand Medicaid. You can learn if you qualify for Medicaid in your state. Just complete the state Health Insurance Marketplace application at www.healthcare.gov.
You can find detailed information about both Health Insurance Marketplaces and Medicaid coverage in your state by using our Marketplace and Medicaid Expansion Interactive Map
For more healthcare reform answers, visit the following websites: