The Health Insurance Marketplace is the biggest change to the structure of the American health care system in a long time. This is a web-based service where consumers and small businesses in every state (including DC) can compare and buy qualified health insurance plans. This option provides group insurance to individuals who previous may not have had access to health insurance. Individuals and families can apply for coverage online, by phone, or with a paper application.
Anyone can purchase coverage through the Marketplace. If you do not want to accept your employer’s health insurance, if you are not eligible for Medicaid, or if you do not otherwise have access to health insurance (i.e., you are uninsured), you may purchase health insurance in the Marketplace. Remember that the individual insurance mandate requires that you have health insurance beginning on January 1, 2014. Open enrollment in Marketplace plans begins on October 1, 2013. You or a family member may be eligible for tax credits or subsidies to purchase from the Marketplace.
Individual and small group health insurance plans sold inside (and outside) of the Marketplace must include must cover a package of 10 categories of items and services known as Essential Health Benefits (EHBs).
Insurance plans offered in the Marketplace are called qualified health plans (QHPs). QHPs are insurance plans that are certified by the Marketplace, provide essential health benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements. A QHP will have a certification by each Marketplace in which it is sold.
When you purchase health insurance in the Marketplace, you will have access to insurance plans that are assigned different “metal levels”. Beginning January 1, 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors.
Each plan offered through the Marketplace has some requirements regarding providers who will be included in their network. Hemophilia Treatment Centers (HTC), for example, are a type of essential community provider, but that doesn’t guarantee they will be included and available through the plan you choose. If you choose to find a plan on the Marketplace, check to see if the plan covers treatment at your HTC or hematologist.
Purchasing Insurance in Marketplace
Individuals earning between 100% and 400% of the federal poverty level (FPL) ($23,550 and $94,200, respectively, for a family of four) will have access to premium tax credits (based on income and the number of insured individuals in your family). These credits make purchasing insurance in the MMarketplace more affordable. To determine if you are eligible for tax credits and subsidies, identify your percentage of the FPL your income is. The Henry J. Kaiser Health Foundation maintains a very helpful subsidy calculator . You can enter your income as a dollar figure instead of a percentage of the FPL and it will tell you if you are eligible for tax credits and subsidies. Individuals earning between 100% and 250% FPL will have access to cost-sharing subsidies that will bring down their deductibles, copayments, and coinsurance.
The Marketplace also includes information on programs that help people pay for coverage. This includes ways to save on monthly premiums, out-of-pocket costs, and other programs like Medicaid and the Children’s Health Insurance Program (CHIP).
If you choose to purchase health insurance coverage in the Marketplace, verify that the plan you choose offers the best coverage for your bleeding disorder needs at a price you can afford. States are at various stages in terms of making publicly available the plans that will be offered in the Marketplace, what the premiums will cost, what the benefits packages will look like, etc. Beginning October 1, 2013, you can check plans and pricing in your state. Visit healthcare.gov.
|Essential Health Benefits: HFA Issue Brief View now >>>|
|Marketplace and Essential Health Benefits: HFA Talking Points View now >>>|
|Out of Pocket Maximums. The Affordable Care Act (ACA) sets maximum limits on how much a person can be required to pay out-of-pocket annually for his or her health care: HFA Issue Brief. View now >>>|
|With this calculator, you can enter different income levels, ages, and family sizes to get an estimate of your eligibility for subsidies and how much you could spend on health insurance. As premiums and eligibility requirements may vary, contact your state’s Medicaid office or exchange with enrollment questions. View now >>>|
|Tax Break Can Help With Health Coverage, But There’s A Catch – Fact sheet on tax credits and subsidies View now >>>|
|This link includes an interactive map that allows you to click on a state and learn about the marketplace developments in that state. View now >>>|
|Marketplace Levels of Coverage: APLUS brief View now >>>|
|Marketplace Primer: APLUS Overview brief View now >>>|
|Extensive toolkit developed by the National Hemophilia Foundation (NHF) and APLUS Coalition which HFA is a part of. View now >>>|
|U.S. Government Site for Health Insurance information View now >>>|
Learn More in a Practical Way!
Disclaimer. This website is a resource only and should be used for information purposes. Please work with your health care providers, insurance councilors, etc. to determine the best solution for you.