The Healthcare Marketplace
The fate of the American health care system has come under some scrutiny since the inauguration of Donald Trump in January 2017. The current President has proposed his own health care scheme, dubbed Trumpcare, in the wake of former President Obama’s relatively unpopular Obamacare. However, the total dismantling of the structure of Obamacare has proved to be incredibly difficult, both in theory and in practice.
As Obamacare makes way for Trumpcare, one area that remains incredibly important for the health care system in the United States is the healthcare marketplace. The healthcare marketplace gave people without health insurance the ability to shop around for the best insurance options in their state without having to be worried about being turned away for pre-existing conditions.
The healthcare marketplace was created on October 1st, 2013, as a part of President Obama’s plan to revolutionize the American healthcare industry. The healthcare marketplace was created under the Affordable Care Act, or ACA, which is also known as Obamacare. The marketplace was available on both federal and state levels, giving people the option to search for subsidized health care plans based on where they lived.
What is the healthcare marketplace?
The health care insurance marketplace is a collection of private health care providers that have been accepted into the government health insurance program, located at healthcare.gov. Individuals without health insurance can sign up on the website during the open enrollment period. After you fill out an application, you will see the insurance plans that you qualify for and how much each plan costs. Health insurance purchased through the marketplace is subsidized by the US government to make health care more affordable for citizens and legal residents of the United States.
The marketplace changed some aspects of the insurance industry to make it more accessible. For instance, the ACA mandated that insurance agencies involved in the marketplace could not deny someone coverage based on pre-existing conditions. Insurance agencies must pass a very strict series of requirements before they can list their policies on the health care website.
All insurers located in the marketplace are required to cover essential health benefits. These include general check-ups, vaccines, prenatal care, and more. Insurers are not allowed to discriminate based on your pre-existing medical conditions, your current health, your previous insurance claims, your gender or your occupation. In fact, your insurance policy will cover care and medication for any medical issues you have, regardless of whether they were pre-existing or not. Your policy will make sure you are given the care you need. Insurance companies still take income, your age, any tobacco use, family size, and where you live into consideration when offering you different insurance policy options, as these factors are highly important for analyzing what kind of insurance policy you qualify for.
Some individual states created their own healthcare marketplaces, which can be used by residents of that state. These state-run marketplaces often have different enrollment periods than the federal health care website does, so you have more time to sign up for them than for the federal healthcare marketplace. If you do still want to register with the federal marketplace, but missed the open enrollment deadline, you can apply for an extended 60 days if you qualify under special circumstances. These special circumstances could include a recent relocation to a different state, changes in your family status, and changes in your financial situation.
How does the marketplace work?
The healthcare marketplace takes information about you, such as your tax records, current income, and existing health insurance information, and puts them together to create a list of insurance policies that are affordable and meet your needs. This allows you to pick from a set of insurance options that will cover you and your family, rather than sifting through a lot of unhelpful insurance information.
The marketplace seeks to match people without insurance with the best health insurance for them at an affordable price. The goal of the program is to make sure that no American goes uninsured. Health insurance costs can often be prohibitive, even for people with full-time jobs, and the Affordable Care Act was designed to lessen the gap between what people need from their health insurance and what they can afford.
Obamacare makes having insurance mandatory. People with private insurance, insurance through their jobs, Medicare, Medicaid, CHIP, Veterans Affairs, the Indian Health Service, or Tricare all qualifies as having insurance and do not need to apply for insurance using the healthcare marketplace. If you aren’t sure if you qualify for tax credits or one of the subsidized health care plans, enroll in the marketplace. Based on your income, family, and tax information, a health insurance representative will contact you to let you know if you or a member of your family qualify for any tax breaks or other health insurance-related subsidies.
If you missed the open enrollment period for the healthcare marketplace or simply do not want health insurance, you can pay a penalty fee. Individuals and families without insurance will pay a penalty of $95 per person, $285 per family, or 1% of their income, whichever is the greater amount. The penalty was first introduced in 2014 and has grown in the years since; however, individuals with a low enough income will not have to pay the penalty, and health insurance will become more affordable with the financial incentives offered for people and families with low incomes.
Benefits of the health insurance marketplace
The healthcare marketplace gives people the ability to shop around for health insurance policies they can afford without being worried about being turned away. For people with low incomes or for those who own small businesses, additional subsidies and tax breaks are offered so that they can afford insurance for themselves and their employees. This marketplace is an easier way to get insurance without needed to go through an often-expensive insurance broker. Competition in the marketplace gives you more options at better prices and puts everything you need to know in one place.
The marketplace can be used to apply for CHIP and Medicaid as well, and if you are already covered by Medicare, you don’t need to enroll in the open marketplace. Tax credits may not be available to you if you are already insured by your job. You can apply for insurance using the marketplace to cover holes in your existing insurance policy.
Millions of uninsured Americans can buy affordable health insurance because of the ACA. The rate of uninsured individuals and families has dropped, and millions of people found that they could be covered by an adequate insurance policy because of this piece of legislation. Although Obama’s mandate that all Americans should be covered by health insurance was viewed by many as unpopular, the program has seen an increase in insured residents of the United States in the four years of its implementation.
Your health insurance options
The healthcare marketplace offers four tiers of insurance coverage. These qualified health plans all offer the same basic level of coverage, known as the essential healthcare benefits. These are the minimum health care standards that insurance policies are required to have in order to participate in the healthcare marketplace.
The four tiers of insurance are Bronze, Silver, Gold, and Platinum. Each tier offers better benefits and less cost sharing, depending on how much money you are willing to pay for your insurance. The Bronze plan is the lowest available tier, which offers a 40% out of pocket cost on medical expenses. The Silver tier offers 30% out of pocket costs for non-covered items, Gold offers 20%, and Platinum, the highest tier, only makes you pay 10% of out of pocket on items that aren’t covered by your insurance policy.
The higher-end insurance policies may have a 40% excise tax levied on them. The Bronze and Silver plans are considered to be the most affordable of the tiers; this is based on the Affordable Care Act’s definition of affordable, which is 8% of an individual or family’s income.
The healthcare marketplace moving forward
The future of the healthcare marketplace and the Affordable Care Act is unclear. As of the beginning of 2017, the healthcare marketplace was still open and the enrollment period had come and gone smoothly. People were still registering for the marketplace even as the election threw fear and confusion into the mix.
If you bought a health care plan for 2017, your insurance company is obligated to insure you for the duration of your policy regardless of the changes the government may make to the health care industry in the United States. This means it is not legal for the insurance company or the government to take away or alter your coverage while your insurance policy contract is still in effect.
When it comes to renewing or purchasing health insurance for 2018, the situation is less clear. The current administration has been discussing removing the Affordable Care Act, but has yet to come up with a solution that would continue to cover the health insurance needs of the millions of Americans who are insured under Obamacare.