^Watch this 5 minute guide to ACA Marketplace Health Insurance^
The Health Insurance Marketplace
Open Enrollment for ACA (Obamacare) ended 1/15/2023 and begins again 11/1/2023 for plan year 2024. If you currently do not have an ACA plan or if you do, but want to switch to a different plan, you'll need to wait (in most cases) until Open Enrollment, unless you qualify for a Special Enrollment Period (SEP). Plans purchased during Open Enrollment generally become effective January 1 of the following year. Plans purchased during a SEP usually begin the 1st of the month following the month you enroll.
Every health insurance option in the Marketplace will offer comprehensive coverage, also known as the Essential Health Benefits . You can compare all your insurance options based on:
- price,
- benefits,
- quality,
- other features that may be important to you, like dental & vision.
Insurance coverage provided by private insurance companies
When you shop at the Marketplace/Exchange, coverage details will be laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you pay and what coverage you receive before you make a choice. Health insurance companies can't refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.
You may save on your monthly premiums
When you apply for coverage in the Health Insurance Marketplace, you’ll find out if you qualify for a premium tax credit to help lower your premium, which is the amount you pay each month to your insurance plan. The amount of your premium tax credit depends on your most recent estimated household income put on your Marketplace application.
Coverage falls into four categories
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your out-of-pocket costs —the total amount you’ll spend for the year if you need care. The categories are:
- Bronze
- Silver
- Gold
- Platinum
The Marketplace also offers "catastrophic" policies to people under 30 years old and to some people with very low incomes.
Balancing monthly premiums with out-of-pocket costs
As with all health coverage, you will still have to pay a monthly premium.
- Premiums are usually higher for policies that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold policy, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
- With a Bronze policy, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
- Platinum policy will likely have the highest monthly premiums and lowest out-of-pocket costs.
Keep this in mind:
- Be sure to look at your maximum out-of-pocket exposure as this amount represents what your financial exposure is in the event of a bad health-year.
- It may make more financial sense to get a Bronze plan and supplement it with an Accident Plan and/or a Critical Illness plan versus getting a Silver or Gold Plan. Doing so may give you more protection for the really important things for less money.