MARKETPLACE FAQ

Below you can find some Frequently Asked Question.

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When can I enroll?


We’re here to help – shop and enroll now! During the annual Open Enrollment Period from November 1st – December 15th, almost all Americans can enroll in health insurance through the Federal Marketplace. If you enroll by December 15th, your coverage will begin January 1st. Outside of the Open Enrollment Period, you can only enroll if you have a Qualifying Life Event, such as losing your job, losing your health insurance, adopting a baby, or getting married.




What is the Affordable Care Act?


The comprehensive health care reform law enacted in March 2010 (also known as “Obamacare”) that prevents health insurers from denying individuals with pre-existing conditions. ACA also provides qualifying consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.




What are Advanced Premium Tax Credits?


A tax credit provided by the IRS that you can take in advance of filing your taxes for the current tax year to lower your monthly health insurance payment (your premium). If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you’ll have to pay back the excess when you file your federal tax return. If you’ve taken less than you qualify for, you’ll get the difference back. Am I eligible? You may be eligible of APTC if: • You have an annual household income between 100 and 400 percent of the Federal Poverty Line • You are not claimed as a dependent by another person • You are enrolled in coverage (excluding Catastrophic coverage) through a health Exchange • Your employer does not offer insurance that costs less than 9.5 percent of your income and pays at least 60 percent of covered benefits. • You are not eligible for coverage through a government program like Medicaid, Medicare, or CHIP • You do not file a Married Filing Separately tax return




What is the Federal Poverty Level?


The 2021 federal poverty level (FPL) income numbers below are used to calculate eligibility for Medicaid and the Children's Health Insurance Program (CHIP). 2020 numbers are slightly lower, and are used to calculate savings on Marketplace insurance plans for 2021. $12,880 for individuals $17,420 for a family of 2 $21,960 for a family of 3 $26,500 for a family of 4 $31,040 for a family of 5 $35,580 for a family of 6 $40,120 for a family of 7 $44,660 for a family of 8 "Income" above refers to "modified adjusted gross income" (MAGI). For most people, it's the same or very similar to "adjusted gross income" (AGI). MAGI isn't a number on your tax return.




What are deductibles, copays, and coinsurance?


Deductible: The amount you pay for your health care services before your health plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay a smaller copayment or coinsurance for covered services, and your insurance company pays the rest. All Marketplace health plans pay the full cost of certain preventive benefits even before you meet your deductible. Some plans have separate deductibles for certain services, like prescription drugs. Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles. Copay: A fixed amount ($15, for example) you pay for a covered health care service. In most cases, copays apply only after you’ve paid your deductible. Though in some cases, they are applied immediately. Example: Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor’s visit is $15. If you’ve paid your deductible: You pay $15, usually at the time of the visit.If you haven’t met your deductible: You pay $100, the full allowable amount for the visit. Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Generally, plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments. Coinsurance: Instead of paying a fixed amount up front (a co-pay), the co-insurance is a percentage of the total cost you may be required to pay. For example, you might have to pay 20% of the cost of a surgery over and above a deductible, while the insurance company pays the other 80%.




What is Cost Sharing Deductions (CSR)?


A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Marketplace, cost-sharing reductions are also called “extra savings.” If you qualify, you should enroll in a plan in the Silver category to get the most savings.