Federal Marketplace
The Federal Marketplace is major medical insurance available to individuals and small businesses. Individuals are allowed to enroll in Marketplace coverage freely during the Annual Enrollment period that occurs November 1st through January 15th of each year. Outside of this time period, individuals must have a Special Enrollment Period to elect coverage.
Examples of life events that trigger a special enrollment period include:
- Marriage
- Divorce
- Birth of a child, adoption, or a child placed in foster care
- Death
- Changes is residence (moving outside of a current service area)
- Loss of other employer-sponsored health coverage
- Losing eligibility in federal or state health programs (Tricare, Medicaid, CHIP)
Health insurance plans are organized into three different levels to help you see a plan’s general approach to sharing costs with you.
The Gold Plan has a higher premium, however it pays more of your medical costs. This plan would be ideal if you or a family member have medical conditions. When you purchase a gold plan your health insurance covers all in network healthcare costs after you reach your out-of-pocket maximum.
Silver Plans are only good for those who qualify for healthcare discounts called cost-sharing reductions. However you must purchase a silver plan inorder to qualify for financial help. The silver plan also offers a moderate cost when using health services as well as a moderate premium.
The Bronze Plan offers a lower monthly premium with a higher cost out of pocket for care. This plan would be ideal for individuals that are healthy and rarely go to the doctors. The Bronze plan offers the lowest premium of all three.
Generally there are three types of networks available on the individual and family market:
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). In some EPO plans they don’t require a referral inorder to see a specialist.
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. The availability of the networks will change based on state and county.
Health Savings Account (HSA)
A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums.
While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have a High Deductible Health Plan (HDHP) — generally a health plan (including a Marketplace plan) that only covers preventive services before the deductible. For plan year 2022, the minimum deductible for an HDHP is $1,400 for an individual and $2,800 for a family. When you view plans in the Marketplace, you can see if they’re “HSA-eligible.”
For 2022, if you have an HDHP, you can contribute up to $3,650 for self-only coverage and up to $7,300 for family coverage into an HSA. HSA funds roll over year to year if you don’t spend them. An HSA may earn interest or other earnings, which are not taxable.
Some health insurance companies offer HSAs for their HDHPs. Check with your company. You can also open an HSA through some banks and other financial institutions.
What you’ll need to apply for any of these benefits:
- Names and dates of birth for each person in your household.
- Home mailing address, If someone in your household (those you include on your tax return) has a different home address, you’ll need that, too.
- Social Security numbers. Enter each person’s Social Security number. If you leave this blank, you may be asked to provide more information at a later time.
- Is anyone on your application a legal immigrant? If so, you’ll be asked to provide information from immigration documents.
- How you file your taxes. If you file federal income taxes, you may be asked about your filing status and who you claim as a dependent on your taxes.
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