When is Open Enrollment?
Open Enrollment for ACA Marketplace plans typically runs from November
1 through January 15 in most states. To have coverage effective on
January 1, you must enroll by December 15. Outside of this period, you
may only enroll if you qualify for a Special Enrollment Period due to
a qualifying life event.
How much does Marketplace insurance cost?
Costs vary based on the plan you choose, your location, your age, and
your household income. However, 4 out of 5 enrollees can find plans
for $10/month or less after financial assistance. All Marketplace
plans cover essential health benefits, and no one can be denied
coverage or charged more due to pre-existing conditions.
What if I have a pre-existing condition?
Thanks to the ACA, all Marketplace plans must cover treatment for
pre-existing conditions. Insurance companies cannot deny coverage or
charge higher premiums based on your health status. This means you can
get the coverage you need regardless of any medical conditions you may
have.
What are the different plan tiers?
Marketplace plans come in five tiers: Bronze (lowest premiums, highest
out-of-pocket), Silver (best value for most, includes cost-sharing
reductions), Gold (lower deductibles, higher premiums), Platinum
(lowest out-of-pocket, highest premiums), and Catastrophic (for young
adults under 30 or those who qualify for a hardship exemption).
Can I get help paying for coverage?
Yes! Based on your household income, you may qualify for Premium Tax
Credits to lower your monthly premium, and Cost-Sharing Reductions to
reduce your deductibles, copayments, and coinsurance. Most people who
apply through the Marketplace qualify for some form of financial
assistance.
What essential health benefits are covered?
All Marketplace plans must cover essential health benefits including:
ambulatory patient services, emergency services, hospitalization,
pregnancy/maternity care, mental health & substance use treatment,
prescription drugs, rehabilitative services, laboratory services,
preventive care, and pediatric services (including vision and dental).
Do I need health insurance or can I pay the penalty?
While the federal penalty for not having health insurance was
eliminated in 2019, having coverage is still essential. Medical
emergencies can happen to anyone, and being uninsured could mean
facing tens of thousands of dollars in medical bills. Marketplace
plans provide financial protection and access to preventive care.