How to get ready for the Health Insurance Marketplace?

The Health Insurance Marketplace will be open on October 1, 2013. The initial open enrollment period will run from Oct. 1, 2103 through March 31, 2014. Health coverage can start as early as January 1, 2014.

How can you get ready for the Marketplace? What steps need to be taken before October 1?  Read below.

How to prepare to enroll in the Health Insurance Marketplace

Here is the list of suggested steps in preparation to enroll in the Health Insurance Marketplace.

1. Learn about different types of health coverage

You need to know about different coverage types of health insurance plans (HMO, PPO, POS, and High Deductible Health Plans (HDHP)) and how these types meet different needs. Each Marketplace plan is associated with one of the coverage types.

2. Essential Health Benefits and Four Benefit Tier Marketplace plans

Only Qualified Health Plans (QHPs) are allowed in the Marketplace, and all of them include Essential Health Benefits. All QHPs belong to one of four benefit tier plans (Bronze, Silver, Gold, and Platinum) with pre-specified percent of costs covered by each plan (60% for Bronze, 70% for Silver, 80% for Gold, and 90% for Platinum).  Notice that the scope of benefits is the same among the plans, but the percent of the covered costs (known as actuarial value) of those benefits are different among the plans.

If you are younger than 30, or under special circumstances, you are entitled to the catastrophic insurance coverage.

3. Make sure you understand the terminology

Learn the meaning of terms such as premiums, deductibles, out-of-pocket maximum, copayments, coinsurance, and other useful concepts.

4. Learn about Health Insurance Marketplace Subsidies

Financial assistance from the federal government will be provided in the form of Premium Tax Credits and Cost-Sharing Reductions. The individuals and families with income between 138% and 400% of the Federal Poverty Level (FPL) are entitled to a Premium Tax Credit. In addition, people with incomes up to 250 percent of the FPL are entitled for Cost-Sharing Reductions.

All forms of assistance are available only through the Marketplace.

5. Gather basic information about your household income

In order to see whether you are qualified for lower costs on monthly premiums and out-of-pocket subsidies, you need to estimate your income. Use the 2013 Adjusted Gross Income (AGI) and apply to it any changes you expect in 2014.

6. Ask if your employer plans to offer health insurance in 2014

You are eligible to use the Marketplace if you do not have access to adequate or affordable employer coverage:

  • you don’t have insurance through your employer, OR
  • coverage through your employer costs more than 9.5% of your income, OR
  • your employer’s plan does not pay at least 60% of covered health care expenses 

7. Explore current options

Because of the Obamacare regulations, the Marketplace plans will be more comprehensive and therefore, more costly than existing plans. Some insurance companies give you an opportunity to enroll NOW (before the opening of the Marketplace) into one of the existing plans and lock in the current rate for the next year. For many people it may be an interesting proposition!

8. Fill out which Marketplace will serve you

If your state does NOT run the Marketplace, use the government website to apply for coverage, compare plans, and enroll.

If your state runs the Marketplace, use your state’s website. You may find the website for your state in What is the Marketplace in my state?

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For help finding the best Medicare or Individual Health Plan for you, please contact Liberty Medicare or call us at 877-657-7477.


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