As of October 2013, there's one more way to get health coverage. It's called the health insurance marketplace (also known as exchanges). It gives you another way to compare and buy health insurance.
All plans in the marketplace are run by health insurance companies and offer a core set of benefits called "essential health benefits." These benefits include ER care, hospital stays, maternity and newborn care, prescription drugs and preventive care. You can choose from four levels of coverage: bronze, silver, gold and platinum.
Each level may have a few plans to choose from, with bronze having the lowest monthly premium but you pay more for your care. Platinum plans have the highest monthly premium, but you pay less when you get care.
View a graphic showing how the health insurance marketplace works
How it impacts you
- You have new choices for buying a health plan.
- You might get a break on health plan costs through a tax credit or subsidy.
- If you own a small business (with less than 49 workers), you may be able to use the marketplace to get health care for your business.
Can I be turned down for coverage if I sign up?
No. Starting on January 1, 2014, all health plans have to take you no matter what your health status, age or gender is. Some plans may have limits to care based on where you live.
What happens if I go without health insurance?
Without health care coverage, you and your family risk paying a penalty and the possibility of paying a lot of money if you get sick or hurt.
Who will run the health insurance marketplace?
Each state may look a little different. A state can:
- Run its own marketplace.
- Choose to have a marketplace run by the Department of Health and Human Services (HHS).
Who can get coverage through the marketplace?
People buying their own plans and small employers. States can have large companies with 100 or more workers in these plans starting in 2017.
Who qualifies for a subsidy?
- People who are 100 to 400% of the federal poverty level.* That means you make between $11,490 and $45,960 a year (in 2013).
- A family of four that is 100 to 400% of the federal poverty level,* meaning you make between $23,550 and $94,200 a year (in 2013).
- People who are up to 250% of the federal poverty level. This group might get an additional subsidy with a silver level plan.
Is the marketplace the only way to buy coverage?
No. You can still buy your health plan directly from an insurance company.
What if I don't have Internet access?
You can call a toll-free number, and someone can help you pick a plan and sign up.
*Keep in mind, if you're not eligible for a government-sponsored program, like Medicare or Medicaid, or other sources of minimum essential coverage, you may still qualify for financial support to lower your premium through a tax credit or subsidy if your income is between 100% and 400% of the federal poverty level.