The Health Insurance Marketplace
What is the Health Insurance Marketplace?
A Health Insurance Marketplace is an online marketplace where individuals will be able to comparison shop for health insurance coverage, much the same way you shop for auto insurance online. A similar marketplace exists for businesses, and is called the Small Business Health Options Program (SHOP) Marketplace. States have been given the option to set up their own marketplace, partner with the federal government to run a marketplace, or let the federal government run the marketplace for them. In Michigan, we will operate with a Federally-Facilitated Marketplace (FFM).
Can anyone buy insurance from the marketplace?
Yes, anyone can shop for, and purchase, insurance on the individual marketplace. However, for those being offered affordable coverage via their employer, it is unlikely to be financially advantageous to do so.
Companies with 50 or fewer FTEs can use the SHOP Marketplace. For businesses that qualify for the small business health care tax credit, using the SHOP is a requirement for receiving that credit. Read more about the benefits of the SHOP here.
Most Americans will continue to get their health insurance through their employers, not through the marketplace.
How do I use the Marketplace?
You will go to the Marketplace website and fill out a simple application to see if you qualify for discounts or other coverage such as Medicaid or Medicare. Then you can start using the online Marketplace to compare different coverage options from different health insurance providers and choose the one that meets your needs and your budget.
What kind of coverage can I get through the Marketplace?
All plans offered through the Marketplace have to offer a set of essential benefits. These essential health benefits will include hospital, emergency, maternity, pediatric, drug, lab services, and other care. Annual deductibles will be capped at the amounts allowed for health savings accounts – currently nearly $6,000 for individual policies and $12,000 for family plans. Plans will be divided into four different types (bronze, silver, gold or platinum) based on the level of benefits.
How much will my health insurance cost through the Marketplace?
That will depend on many factors including the type of plan you choose and what, if any, discounts you qualify for. Bronze and silver plans will be capped at 9.5 percent of your income for 300-400 percent of the federal poverty level, while the gold and platinum plans can cost no more than 12 percent of your income.
What discounts can I qualify for?
You may qualify for discounts to help pay for premiums if your income is below 400% of the Federal Poverty Level. Read more about both the two types of subsidies available to qualifying individuals who purchase on the Marketplace: The Advanced Premium Tax Credit, and cost-sharing assistance. You may also qualify for programs such as Medicare, Medicaid, and the Children's Health Insurance Plan (CHIP). View our Three Health Care Options Slideshare for more information.
When can I start using the Marketplace?
The Health Insurance Marketplace and the SHOP Marketplace are scheduled to begin operating Oct. 1, 2013.
How can I get help?
The Marketplace will operate toll-free hotlines to help you choose a plan, determine your eligibility for federal subsidies or Medicaid, rate plans based on quality and price, and conduct outreach and education. The marketplace will provide several customer assistance tools including comparisons of prices, quality, and physicians and hospital networks. You can also get more information at these websites: