Obamacare provides health coverage to people of all income levels. Some American residents also qualify for premium tax credits or subsidies to lower the costs of health care coverage.
Law requires insurance companies to cover essential services like preventive care with low deductibles or copays, so more people can access screenings and treatments designed to keep them healthy, avoid expensive medical issues, and reduce future costs.
1. Your State’s Marketplace
Your state Marketplace is your one-stop shop for affordable health plans tailored specifically to you and your budget, and is also where qualifying individuals may receive subsidies, which translate into lower premiums for Affordable Care Act (ACA)-compliant policies.
The Affordable Care Act established health insurance exchanges as a way for people to easily find and purchase cost-effective yet high-quality coverage. Individuals, families and small businesses alike can easily compare and enroll in plans from a range of providers.
New Yorkers can shop and enroll in Marketplace plans through NY State of Health: The Official Health Plan Marketplace or Small Business Marketplace; employers with 50 or fewer employees can do the same through SHOP Exchange.
Open enrollment for Marketplace coverage runs between November 1 and January 31, but some states offer special enrollment periods outside these dates if there has been a qualifying life event, such as losing or gaining coverage.
2. The Federal Marketplace
If you qualify, enrolling in health insurance through the federal Marketplace is an effective way of accessing plans that qualify for government subsidies, such as cost-sharing reductions and advance premium tax credits.
The Marketplace provides a selection of plans to choose from, such as Platinum, Gold, Silver and Bronze plans. Each type offers the same essential health benefits but differs in terms of out-of-pocket expenses.
Open Enrollment period typically occurs annually in most states from November 1st through January 15th; however, special enrollment periods may allow you to enroll outside this timeframe should an unexpected life event arise such as losing current coverage or giving birth.
Navigators assist consumers with both electronic and paper applications to establish eligibility and enroll in Marketplace coverage. In addition to helping with application preparation, navigators provide outreach education programs as well as referrals to health insurance ombudsmen or consumer assistance programs and ensure consumers have all of the information needed when selecting coverage options.
3. The Health Insurance Exchange
Individual health insurance plans can only be purchased through state-based exchanges (also referred to as marketplaces). Here, you will be able to find affordable plans compliant with the Affordable Care Act which offer premium subsidies and cost-sharing reductions.
Exchanges were established as part of the Affordable Care Act to help individuals and families purchase individual and family plans that provide 10 essential health benefits, including preventive care. You can compare plans side-by-side in exchanges while applying for subsidies if applicable.
Registering in the exchange is free, both online and via telephone. Simply input your income and family size details to see if you might qualify for savings in costs.
States also enjoy considerable leeway when selecting plans certified for sale through exchanges, which has an enormous effect on how an exchange fits into and participates with their larger health care marketplace. Furthermore, this decision could prevent adverse selection – or enrollment of high-risk, high-cost individuals that could cause increases in premiums – which may lead to adverse selection resulting in increased costs and premiums.
4. The Marketplace for Small Businesses
Small businesses employing 100 or fewer employees can benefit from accessing health insurance plans through the Marketplace for Small Businesses program, which offers tax credits to help offset some costs.
If your company employs less than 25 full-time workers and pays at least 50% of premiums for these employees, the Small Business Health Care Tax Credit may be eligible to you. This incentive is open both tax-exempt employers as well as non-profit ones.
Small businesses also have the option of joining purchasing alliances or associations, commonly referred to as private exchanges, in order to offer multiple health insurance options to their team without taking advantage of SHOP (The Small Business Marketplace for Small Businesses).
The Affordable Care Act mandates that companies with 50 or more employees must offer qualified health coverage or face a no-coverage penalty. This doesn’t preclude offering health benefits to your staff; rather, it means being aware of ACA requirements and their impact on your business.