Choosing Marketplace Coverage

Do I qualify for Marketplace coverage?

If you don’t get health insurance through your employer, you can shop for plans on healthcare.gov. To be eligible for Marketplace coverage, you:

• Must live in the United States.
• Must be a U.S. citizen or national (or be lawfully present).
• Can’t be incarcerated.

Usually each year, from November 1 through January 15, you can shop for health plans during open enrollment. This is the only time all year you can buy plans for the upcoming year unless you have certain life events like:

• Losing other coverage
• Getting married
• Moving
• Having a baby or
• Your income is near the federal poverty level and changes frequently

Any of these situations may make you eligible for a special enrollment period. To find out more, click here.

What life changes qualify me for a special enrollment period for a Marketplace plan?

Generally speaking, you can only purchase new ACA policies during open enrollment periods. Open enrollment (a period of time to purchase coverage for the upcoming year) is usually from November 1 through January 15.

However, certain situations can make you eligible to purchase coverage at any time. Examples include losing other health insurance, which might happen if you lose a job, get married or divorced, have a baby or adopt, move your residence or if your income is near the federal poverty level and changes frequently. You can call us at 844-481-3770 or visit Healthcare.gov to see if you qualify for a special enrollment period.

What do I need to sign up for Marketplace coverage?

To apply for or re-enroll in your Marketplace coverage, call us at 1-800-352-2583.

You’ll need to provide the following information on your Marketplace application. So it’s a good idea to gather everything before you get started. Note: You won’t need all of it if you’re applying without a subsidy (tax credit).

• Basic personal information like name and date of birth for everyone applying for coverage
• Details about each person in your household (even those not applying for coverage)—including your spouse, children living with you and anyone you claim as a dependent on your tax return
• Home and mailing address (if these are different) for everyone applying for coverage
• Social security numbers for everyone on your application
• Information about any professional who might be helping you apply, such as a navigator, agent or broker
• Immigration document information (applies only to lawfully present immigrants)
• Federal income tax information, such as whether you file jointly or separately, if you’re married and who you claim as a dependent
• Income details for everyone in your household (even for those not applying for coverage)—including wages and salaries as reported on your W-2 form and pay stubs, net self-employment or business income, unemployment pay, social security payments, alimony, retirement and rental income
• Best guess of your household income for the year you’ll be covered
• Health coverage information (applies only if anyone in your household has a health plan right now)

What do the metal levels in the Marketplace mean?

Metal categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care. Which metal category is right for you?

Bronze

• Lowest monthly premium
• Highest costs when you need care
• Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.
• Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.

Silver

• Moderate monthly premium
• Moderate costs when you need care
• Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.
• IMPORTANT: If you qualify for cost-sharing reductions you must pick a Silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you use a lot of care.
• Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.

Gold

• High monthly premium
• Low costs when you need care
• Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.
• Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.

Platinum

• Highest monthly premium
• Lowest costs when you get care
• Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
• Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.

What life changes qualify me for a special enrollment period for a Marketplace plan?

Generally speaking, you can only purchase new ACA policies during open enrollment periods. Open enrollment (a period of time to purchase coverage for the upcoming year) is usually from November 1 through January 15.

However, certain situations can make you eligible to purchase coverage at any time. Examples include losing other health insurance, which might happen if you lose a job, get married or divorced, have or adopt a baby, move your residence or if your income is near the federal poverty level and changes frequently. You can call us at 844-481-3770 or visit Healthcare.gov to see if you qualify for a special enrollment period.