The Health Insurance Marketplace and You

What is the Health Insurance Marketplace?

Often referred to simply as the “Marketplace” or the “Exchange,” this service helps you shop for and enroll in health insurance for you and your family through websites, call centers and in-person help. (The Marketplace is not for people who get insurance through their employer.)

When you apply for individual and family coverage through the Marketplace, you’ll provide income and household information. You’ll find out if you qualify for:

• Premium tax credits and other savings that make insurance more affordable
• Coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state

Click here for a quick start guide to the Marketplace. You can also get a quote for Florida Blue coverage here.

What are subsidies and the Advance Premium Tax Credit?

If you purchase your own coverage for you and your family, the government may help pay a part of the cost of your health care coverage premium. The premium is the monthly cost for a health care policy. The government help is called a “subsidy.”

The subsidy is a tax credit called the advance premium tax credit and it can be applied directly to your monthly premiums, to help lower your health plan cost.

Use the Health Care Tax Credit Estimator to determine your eligibility. The government reviews information such as:

• Your household income
• Your family size and individual ages
• The county where you live

The amount of financial help you get will be based on this information. If you qualify, you'll pay a lower monthly amount for your Florida Blue health plan. The government will pay the rest of it.

Talk with us one-on-one to have your questions answered. We can explain your options and guide you through the next steps to purchasing health insurance for you and your family. Contact a Florida Blue Center near you today.

What are essential health benefits?

Since the passing of the Affordable Care Act in 2010, all plans must cover these 10 essential health benefits:

·       1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)

·       2. Emergency services

·       3. Hospitalization (like surgery and overnight stays)

·       4. Pregnancy, maternity and newborn care (both before and after birth)

·       5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

·       6. Prescription drugs

·       7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

·       8. Laboratory services

·       9. Preventive and wellness services and chronic disease management

·       10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Plans must also cover birth control and breastfeeding.

These are the minimum requirements any health plan must offer. Florida Blue also offers many programs and services to help you achieve your best health.

Can I still get coverage if I have a preexisting condition?

Since the Affordable Care Act (ACA) was passed in 2010, everyone can get a health plan now, no matter what their health history is. Preexisting conditions will no longer apply for qualified health plans issued under the ACA.

You can buy one of the health plans, even if you are sick or have had health problems in the past. Everyone who applies for health insurance can get coverage. Once you have a health plan, your coverage cannot be canceled if you have a health problem. If you use tobacco, you’ll pay more for your health plan.

When does coverage start?

If you didn’t make a payment when you applied for coverage, you’ll need to make your payment in full before your coverage will start. Look for a payment letter and a bill in the mail.

It takes up to 10 days to process your payment. If your payment is still processing when your coverage takes effect and you need care right away, there will be a few extra steps to verify your payment and coverage first.

Pay by phone or online 24/7
Call: 1-800-352-2583
Visit: www.floridablue.com/paynow

You can pay with a credit card, a debit card or by electronic funds transfer (EFT). Follow the prompts and select the option ‘Make a Payment.’

You'll need:

• Member number
• Social Security Number
• Zip Code
• Birthdate
• Bank or credit card information