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Glossary > Health Insurance Marketplace (Exchange)

Health Insurance Marketplace (Exchange)

What Is the Health Insurance Marketplace?

The Health Insurance Marketplace is a service that people can use to buy commercial, or individual and family health insurance policies. Most states use healthcare.gov, which is owned and operated by the federal government, as their marketplace, while other states have their own online marketplaces.

 

Health Insurance Marketplace Definitions & Terms

Here are some important terms to know when shopping in the Health Insurance Marketplace:

 

1) Health Insurance Marketplace/Exchange -

The service that helps individuals, families and businesses buy ACA-approved health plans. 

2) Actuarial value -

The percentage of total average healthcare costs that a Marketplace plan will cover. The ACA has four tiers of plans, sometimes referred to as metal tiers, with different actuarial values. 

3) Premium tax credits -

A tax credit that lowers the cost of monthly health insurance payments for low-income individuals. In order to qualify, a person must fall between 100% and 400% below the federal poverty line. 

4) Children's Health Insurance Program (CHIP) -

A state-governed program that offers affordable, low-cost health insurance to children up to 18 years old in qualifying households. Eligibility criteria vary by state. 

5) Open Enrollment -

A period during each calendar year when eligible individuals can apply for new health insurance policies or switch from their current policies.  

6) Special Enrollment Period -

A 60-day period that is triggered by a person experiencing a major change in their life that would prompt the need for new health insurance, such as getting married or having a baby. The events that qualify you for a special enrollment period are called "qualifying events."

 

Who Controls the Marketplace?

The Health Insurance Marketplace is run by the U.S. federal government, but some states have their own health insurance marketplaces for legal residents.  You can find out whether or not your state has it’s own health insurance marketplace at www.healthcare.gov.

 

Enrolling Through the Marketplace

You can enroll through the Health Insurance Marketplace during the annual open enrollment period, or if you had a qualifying life event, you may be eligible for a special enrollment period that usually lasts 60 days. 

The Health Insurance Marketplace can be accessed via healthcare.gov, and If your state has its own healthcare exchange, you will be redirected to the appropriate website.  If it's outside the open enrollment period, you can still comparison shop to figure out the best plan for you.

 

Who Can Enroll Through the Marketplace?

Any qualifying adult can enroll through the Health Insurance Marketplace. As long as you are 18 years old, or older, you can apply. Those who qualify for healthcare assistance can explore low-cost and free health insurance options like Medicaid. 

 

When Can You Enroll Through the Health Insurance Marketplace?

You can enroll through the Marketplace during the annual open enrollment period, or during a special enrollment period if you qualify.

This year, the 2018 open enrollment period begins on November 1, and end on December 15.  This is a much shorter open enrollment period than in past years, but there is always a possibility that open enrollment will be extended, so make sure to keep up to date, or follow First

 

Are There Options Outside of the Marketplace?

Yes. There are thousands of private health insurance companies out there with competitive prices. Using a free service like First Quote Health, you can get instant quotes from providers in your area.