How to Navigate ObamaCare (the Health Insurance Marketplace): Step by Step Guide
Introduction
With health insurance, the seemingly complex world of it can be hard to keep up with and that is even more so true in today’s rapidly changing healthcare landscape. The Affordable Care Act (ACA) has changed the way all Americans do their health coverage shopping by establishing a direct enrollment platform for individuals and families to shop, select and pay online in an organized marketplace. This ultimate guide helps to break down the complexity of browsing through Health Insurance Marketplace, and provides a step-to-step template for you so that you can make well-informed decisions in buying coverage.
MarketPlace Health Insurance?
Health Insurance Marketplace is a complete online service where consumers can compare health insurance and choose the suitable plan. It was a way to create greater transparency and choice in health insurance. The Marketplace has different levels of plans that offer varying degrees of coverage so you can choose the plan which best suits your need and budget.
Marketplace Open Enrollment Period
But, before getting into the step-by-step guide to maneuver through the Marketplace it is important that you know a few fundamental concepts and terms related to health insurance:
1. Open Enrollment Period
The Open Enrollment Period is an annual period during which individuals can enroll in health plans through the Marketplace. This is the only time you can apply for Marketplace coverage before the next Open Enrollment Period. — Outside of open enrollment, if your income changes or for other special circumstances (such as marriage, childbirth), you may be eligible to apply due a Special Enrollment Period
2. Kinds of Medical Insurance Programs
Marketplace plans are separated into four metal tiers: Bronze, Silver, Gold and Platinum. Each level has a different cost-sharing structure”)!=
Bronze (Lowest monthly premium, highest out-of-pocket costs)
Silver: Lower monthly premium, moderate costs.
Gold More expensive monthly fee, lower out-of-pocket costs
The possibility of this is reduced with Platinum plans, which have the highest monthly premiums but come paired with lowest out-of-pocket costs.
3. Premiums and Subsidies
Premium — A premium is what you pay each month … in return for health insurance coverage. You may also be eligible for lower costs on your monthly premiums and out-of-pocket expenses depending on your income. The Marketplace operates on an income-based sliding scale for determining eligibility, and makes health insurance more affordable to low- and moderate-income individuals (and families).
4. Essential Health Benefits
Offers a variety of health benefits, including:
Emergency services
Hospitalization
Maternity and newborn care
Behavioral Health and Substance Use Disorder Services
Prescription drugs
Preventive and personal wellness services
Pediatric services
Understanding the Marketplace: A step-by-step guide
Part 1: Are you eligible or not?
Get answers about eligibility for the Marketplace before you apply. By and large the below things are considered for:
You must reside in the U.S.
You need to be a U.S. citizen or qualified alien
You can not end up in jail (other than for pre-file fees).
:STEP 2 : COLLECT REQUIRED DETAILS
Please start by preparing the following information to apply:
Social Security numbers (or I-94, Visa, Passport)
Information for every member of your houshold (employer, income)
Policy numbers for any existing health insurance plan(s)
Step 3: Create an Account
Go to the Health Insurance Marketplace website (HealthCare. gov) to create an account. Register Account — You will need to register an account that requires your email address and you create a password. Once your account has been created you can then start the process for an application.
Step #4: Your Application Is Ready Now
You will complete it by providing basic information about yourself and your household. They will ask you about your household size, income and if anyone else in your home is currently covered by a job-based plan. Answer truthfully and in detail, since these details will help you learn whether or not you can qualify for subsidies depending on the plans to which you are able to enroll.
Lesson 5: Check Your Eligibility Results
You should expect to get a notice about whether or not you’re eligible for Marketplace coverage and any available help paying your share of the premium after you submit your application. HealthCare.gov will tell you how much financial assistance is available, and an estimate of your premium by selecting the coverage level that fits best for income or household size.
Step 6: Research the options
After you understand your eligibility and what it might cost, then shop around for the health insurance plans that are available. You can filter plans in the Marketplace based on
Premium costs
Deductibles
Out-of-pocket maximums
Coverage of specific services
Look at the specifics of each plan — its doctors, hospitals and more.
Step 7: Choose a Plan
Compare the plans you have available to make an educated decision and pick a plan that covers all of your health needs while still staying within your budget. Think about things such as how much you will likely use healthcare, which doctors you prefer to see and what your out-of-pocket costs might be.
Step 8: Sign-Up for the Plan of Your Choice
You can then choose to enroll in the health plan indicated by following the instructions. You may be required to provide any new details needed by the insurance company and reconfirm that you are engaged – this typically happens every 30 days.
Step 9: Review Your Coverage
Once you are enrolled, check the details of your new health insurance plan closely. Verify how soon you can have coverage, your premiums and other information about whatever proof that’s needed.
Stage 10 — Use Your Advantages
Now that you have health insurance, it is time to start using your benefits. Arrange for your regular check-ups, preventive services and any care that you need. You need to keep record of your medical bills and the amount claimed, so that you can make full use of this benefit.
How to Make it in the Marketplace
Launch Your Plan Search Early: Apply early in the Open Enrollment Period to reduce last-minute grief.
When in Doubt, Ask: Use Marketplaces customer service reps and online chat support for any questions you may have.
Stay up to date: Learn about new developments in health insurance laws and Marketplace rules that may change your coverage.
Once a Year Review — Even if you are happy with your current plan be sure to look at other plans offered during Open Enrollment each year as premiums and coverage can change.
Conclusion
The Health Insurance Marketplace can be daunting at first glance, but this step-by-step guide will lay out what you need to know and how you may approach the system. Knowing in advance your eligibility for this coverage as well having on hand the basics will let you to accurately compare plans and see which is best suited for yours, or even your family. Keep in mind that health care is the foundation of your overall well-being, so make sure you know all about it and choose wisely. Having a solid plan in place allows you to turn your attention back towards what matters; Keeping yourself, and your sanity healthy!