Health Insurance Marketplace Overview

What is the Marketplace?

Despite the recent executive actions by President Trump, there has been no change to the Affordable Care Act (ACA) requirement that all individuals have health insurance for 2018 or be subject to a penalty. If you do not have health insurance, you may have the option of finding health insurance through the “Health Insurance Exchange” or “Health Insurance Marketplace” – a government website where you can compare and purchase a health insurance plan that best fits your needs and budget.

What is Open Enrollment?

Like other medical insurances, there is a set open enrollment period in which individuals must purchase coverage. Exchange open enrollment for 2018 coverage was November 1-December 15, 2017. If you did not apply for coverage during those dates, you will need to have a “significant life event” in order to enroll in coverage. These life events include: 

  • Moving to a new state
  • Marriage/divorce/death
  • Birth/adoption
  • Change in income
  • Loss/gain of employment
  • Loss of insurance from another source
  • Release from correctional facility
  • Recent immigration
  • Change in citizenship
  • Victim of domestic violence
  • 26th birthday
  • Enrolled in an Exchange plan/Exchange insurer in 2017 that was discontinued for 2018 (qualifies consumers for special enrollment period through March 1st, 2018)

If you feel you may fit into any of the above life situations, log onto healthcare.gov to enroll or contact a Certified Application Counselor for enrollment assistance.

What are my Coverage Options?

Each state has different insurance companies who have chosen to offer plans in the Marketplace. Individuals will be able to choose from bronze, silver and gold plan options (at a minimum). All plan options will cover minimum essential health benefits. The primary difference in the coverage options is in the cost of the monthly premiums and the amount you will pay out of pocket for co-pays and to meet deductibles. When selecting a plan, make sure your plan covers the services you think you might receive and is in-network with the service provider you wish to receive care from.  A Certified Application Counselor can help you decide which plan is right for your needs and your budget.

Discounts Available

Based on your household income, you may qualify for a tax credit that will lower how much you pay for your health plan premium each month.  You may also qualify for cost-sharing reductions that can lower how much you spend out of your own pocket for covered health services. To see if you qualify for a subsidy to assist you with your monthly premiums, you can use the subsidy calculator at www.healthcare.gov under "Preview health plans and prices based on your income." You can also contact a Certified Application Counselor who can help you determine what discounts you are eligible for.  

Penalties for Not Enrolling

If you don’t have health insurance in 2018, you will pay a penalty when you file your federal income taxes in 2019.  In 2018, the penalty is the larger amount of: 2.5 percent of your income or $695 per adult, $347.50 per child, up to $2,085 for a family. Individuals who are penalized are still responsible for paying 100% of their medical bills, in addition to the penalty. 

Questions and Enrollment

With one application, you can see all of your plan options, the discounts you qualify for, and enroll in a plan. To apply online, visit healthcare.gov.  Certified Application Counselors are also available to answer questions, assist with the enrollment process, or even meet with you in-person.  Since different plans are offered depending on the state in which you reside, use the below numbers to be connected with a Certified Application Counselor who is trained in plans for your state: 

Missouri residents: Call 855-900-4140, email MCAP@mercy.net or visit www.healthcare.gov.

Residents of all other states: Call 800-318-2596 or visit www.healthcare.gov.