Friday, October 4, 2013

Healthcare Marketplace: The Nuts & Bolts

On October 1st, the portal for the more than 30 health insurance exchanges being run by the federal government and the marketplaces operated by 16 states and the District of Columbia, opened to the public for enrolling in healthcare plans  under the requirements of the Affordable Care Act. Enrollment for individuals and families is open from October 1, 2013 – March 31, 2014. Enrollment for small businesses lasts year round. 

The website features two separate marketplaces to purchase insurance plans. The first, widely-publicized, marketplace is the “Health Insurance Marketplace” for individuals and families. The second marketplace is the Small Business Health Options Program, or SHOP Marketplace, available for small business employers with 50 or fewer employees.

Available Plans

The marketplaces offer several choices for employers and individuals to choose from. As with all health insurance plans, individuals and employees will have to pay a monthly premium. Employers may choose to contribute to these premiums to lower the monthly costs for employees. Employers that do contribute to premiums may qualify for a tax credit. You will be able to choose from: Platinum, Gold, Silver, Bronze and Catastrophic health insurance plans. Coverage will begin as early as January 1, 2014. 
The differences in the plans are the price of monthly premiums, deductibles, and copayments and the breadth of available doctors to choose from on each plan.  All the available healthcare plans must cover a specified list of preventative services at no cost.
The catastrophic health insurance plan is only available to individuals under 30 and to some low-income people. Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer.

Health Insurance Marketplace

The Health Insurance Marketplace is the marketplace for individuals and families to purchase health insurance plans. Individuals and families may be eligible for lower costs on monthly premiums and out-of-pocket costs, or get free or low-cost coverage.
Medicare & Medicaid: Individuals covered by Medicare and Medicaid do not need to enroll in the Health Insurance Marketplace and the choices and benefits afforded to these individuals will not change.  Individuals that do not qualify for Medicaid now may qualify for the program in 2014. In many states the eligibility for coverage is expanding to cover more individuals.

Questions about Medicare are addressed here:

Questions about Medicaid are addressed here:

  • At the bottom of the screen you may select your state of residence to learn more about Medicaid expansion in your state.

Health Insurance Marketplace Information:

SHOP Marketplace (Small Business Health Options Program)

The Small Business Health Options Program (SHOP Marketplace) is designed to help employers with 50 or fewer full-time equivalent employees select a healthcare plan. The website allows employers to fill out a single application to compare price, coverage, and quality of plans in a simple straight forward manner that any layperson can understand.  Self-employed individuals will not use the SHOP Marketplace and should instead use the Individual Marketplace.

The SHOP Marketplace also provides information on the small business healthcare tax credit. To qualify for the tax credit the small business must get coverage through the SHOP Marketplace.  The maximum tax credit available is a credit for half of the amount of the premium contribution made by the employer.

SHOP Marketplace Information:

  • Phone number: 1-800-706-7893 (TTY users: 1-800-706-7915).Hours: Monday through Friday, 9 a.m. to 5 p.m. EST

Helpful Links

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