05. June 2016 · Comments Off on The 5 W’s of Marketplace Health Insurance · Categories: Health Insurance

Knowledge based on the 5W’s of marketplace health insurance should serve as a reliable foundation for understanding and choosing coverage which meets the qualifications of the Obama health plan. The 5W’s stand for what, why, who, when and where.

What is marketplace health insurance?

Marketplace health insurance is coverage obtained through one of the governmental health insurance exchanges which provides a minimum standard of benefits known as the essential health benefits as specified by the Patient Protection and Affordable Care Act, referred to by many as ObamaCare. The plans are sold by private insurance companies and generally are HMO and PPO plans. Each plan has a metal designation of bronze, silver, gold, or platinum, depending upon services covered and the actuarial value of the plan. Marketplace health insurance plans cannot deny coverage or charge a higher premium for pre-existing illnesses. They cover some preventive care services.

Why purchase marketplace insurance?

The answer to this question rests in Affordable-Care-Act subsidies, also known as premium tax credits, and whether or not you qualify. Eligibility for Affordable-Care-Act subsidies is based on annual household income provided that income is at least 133% but less than 400% of the federal poverty level beginning in 2014. The premium tax credit calculation is based on a provision of the Affordable Care Act that no American should spend more than 9.5% of household income on medical insurance premiums. Given that provision, Obama-health-plan insurance could be purchased outside of the marketplace from a broker or insurance company. The dollar amount of the annual premium in excess of that allowed under the Affordable Care Act for a given income level could then be claimed as an end-of-the-year deduction during income tax filing. If the coverage is obtained through a health insurance marketplace however, the credit can be applied to the monthly premium of any Obama-healthcare-plan selected, resulting in a lowering of the monthly premium of the plan.

Who is eligible to purchase marketplace insurance?

Marketplace health insurance through the federal or one of the state insurance exchanges is for individuals and families less than 65 years of age or small businesses with 50 or fewer employees. Eligibility includes United States citizenship and/or legal residence. Additionally, one must not be incarcerated.

When does having medical insurance become mandatory, when can I enroll, and when does the penalty for not having insurance take effect?

January 1, 2014 is the date that most United States citizens and legal residents must have medical insurance coverage or suffer a tax penalty of $95 per adult, $47 per child, or 1% of the annual household income (whichever is greater) if one is uninsured as of January 1, 2014 and coverage has not been obtained by February 15, 2014. Open enrollment will extend until the end of March 2014. If you have a qualifying life-changing event however, such as marriage, relocation to another state, loss of job-based insurance or expiration of COBRA coverage, marketplace insurance can be obtained as an exception at times after the closure of the open-enrollment season in March 2014 and in subsequent years.

Where can I purchase marketplace insurance?

If you reside in a state whose health exchanges operated by the federal government you will need to purchase through that exchange. Alternatively, marketplace health insurance can be purchased through a private health insurance exchange if it has contractual authority granted by the federal government to enroll Obama health plan applicants. As of December 1, 2013, residents of the District of Columbia and states with state operated insurance exchanges must obtain marketplace medical insurance through the state exchanges. Those states are Those states are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.

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