Dear Addy: The Marketplace

Dear Addy, 

I am looking at health insurance options for 2024 and keep seeing terms like “marketplace” and “open enrollment.” What does this mean? What options may be available to me if I don’t receive insurance through my job?  

Signed, 
Unsure about Insurance 

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Dear Unsure, 

The Marketplace, short for Health Insurance Marketplace, is a shopping and enrollment service for health insurance that was created by the Affordable Care Act. In most states, the federal government runs the Marketplace (sometimes known as the “exchange”) for individuals and families. On the web, it’s found at HealthCare.gov. Some states run their own Marketplaces at different websites – but you can reach all of these by starting at HealthCare.gov. 

The ACA’s open enrollment period is the annual window during which individuals and families can compare the various health plans that are available and select the one that will best fit their needs for the coming year. Beyond the open enrollment period, eligibility to sign up for ACA-compliant individual and family health insurance (or switch plans) is contingent on experiencing a qualifying life event (such as turning 26, getting married, having a child, etc.) that triggers a “special enrollment period.” 

How do I determine if I am eligible for a marketplace plan? 

You are generally eligible to buy health insurance from the ACA Marketplaces, and may be eligible for premium subsidies, if:  

• You have a household income at least equal to the Federal Poverty Level (FPL)¹   
• You do not have access to affordable coverage through an employer (including a family member’s employer).  
• You are not eligible for coverage through Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).  
• You have U.S. citizenship or are lawfully present in the U.S. and you are not currently incarcerated.   

How do I enroll in a marketplace plan? 

If purchasing your own health plan on the individual market, start your search at HealthCare.gov. You can only receive federal premium subsidies for plans bought through the ACA Marketplace. In addition, starting your search on HealthCare.gov will help you avoid short-term health plans, health sharing ministries, and other forms of “skinny,” non-ACA-compliant coverage that provide inadequate  coverage and insufficient financial protection. 

Healthcare.gov is an easy-to-use website that will walk you through all the necessary steps to enroll in marketplace coverage. Here’s how to get started: 

1. Create a Marketplace account: If your state runs its own marketplace, the website will automatically redirect you to your state’s website. 

2. Get ready to apply and gather necessary materials: Use this checklist to gather everything you may need. 

3. Get “Eligibility Results” immediately: Upon submitting your application, you will find out which plans you may qualify for. 

4. Enroll in health coverage: Once you see your options, compare health plans and prices available to you! 

If you get your health insurance through the ACA Marketplace, the “Open Enrollment Period” runs in most states from Nov. 1, 2023, to Jan. 16, 2024.  However, to get coverage that begins on January 1, you must sign up by Dec. 15. 

Important Dates: 

• November 1: Open Enrollment starts for health coverage for the next plan year. This is the first day you can enroll in, re-enroll in, or change health plans through the Marketplace. Coverage can start as soon as January 1. 
• December 15: Last day to enroll in or change plans for coverage to start January 1. 
• January 1: Coverage starts for those who enroll in or change plans by December 15 and pay their first premium. 
• January 15: Open Enrollment ends in most states (though some states run up to January 31).  After this date, you can enroll in or change plans only if you qualify for a Special Enrollment Period. 
• February 1: Coverage starts for those who enroll in or change plans between December 16 through January 15 and pay their first premium. 

Overall, the ACA Marketplace serves as a vital hub for individuals and families to access and enroll in healthcare plans. For more information on open enrollment and marketplace coverage, please visit HFA’s Open Enrollment Guide. Good luck in your search for insurance! 

Sincerely, 
Addy