What do the benefits packages of the plans offered in the Marketplace cover? Do they cover factor, HTCs, my other doctors, etc.?
- Benefit packages and provider networks vary by state and insurance plan. If you think you might want to purchase health insurance in the Marketplace, you should contact your state’s insurance department and ask for all the plan information available for the plans that will be sold in the Marketplace. If the information is not yet available, as when it will become available. You will want to compare plans before October 1, when open enrollment begins.
Do the plans offered in the Marketplace have out-of-pocket limits on drugs and/or medical costs? If so, what are they?
- You will want to look at the plans that will be sold in the Marketplace to determine whether they have established out-of-pocket limits on medical and/or drug coverage. Before you do this, though, you will want to understand how out-of-pocket limits will apply in 2014 and 2015 and beyond.
Even though my employer might provide insurance, does it make sense for me to look at plans offered in the Marketplace? If I do, will I have access to a subsidy to purchase a plan in the Marketplace?
- It might make sense for you to compare plans sold in the Marketplace to your employer-provided coverage, especially if there are specific services and/or providers you want to be sure are covered by whatever plan you choose. Be aware, though, that if you are offered affordable employer-provided insurance, while you can purchase insurance in the Marketplace, you will not have access to tax credits and subsidies, even if your income would otherwise be in the range that would qualify you for them.
What is the difference between purchasing “in the Marketplace” and “outside” the Marketplace?
- If there are insurance plans offered outside the Marketplace, and you choose to purchase one, you will be fulfilling the individual mandate. However, insurance plans offered outside the Marketplace are not necessarily subject to the other regulations described in this section, such as what types of benefits are included. If you purchase insurance inside the Marketplace, you might have access to premium subsidies and tax credits if your income falls into the appropriate range (keeping in mind that if you have access to employer-provided coverage, you will only have access to subsidies and tax credits if your employer’s plan is not deemed affordable and if your income falls into the appropriate range). Additionally, insurance plans sold inside the Marketplace will be assigned metal levels that will offer some predictability about the amount of premiums you will pay. Lastly, insurance plans sold inside the Marketplace must offer essential health benefits.
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.