Individual Insurance

The Affordable Care Act (ACA) authorizes the creation of the Health Insurance Marketplace (also known as the Marketplace or Exchange). The Marketplace will assist individuals and small business owners in shopping for, selecting and enrolling in private health insurance plans. All private health insurance plans offered in the Marketplace will offer the same set of Essential Health Benefits.

Kinds of Marketplaces

The ACA creates two kinds of Marketplaces:

  • Health Insurance Marketplace for Individuals
  • Small Business Health Options Program (SHOP) for small business owners

The ACA delegates primary responsibility for governing and operating the Marketplace to the states, with the federal government, primarily the United States Department of Health and Human Services, setting minimum standards.

Eligibility

To be eligible for health coverage through the Marketplace, you:

  • Must live in the United States
  • Must be a U.S. citizen or national (or be lawfully present)
  • Cannot be currently incarcerated

NOTE: Generally, health insurance coverage in the Marketplace covers health care provided by doctors, hospitals, and medical services within the United States. If you’re living abroad, it’s important to know this before you consider buying Marketplace insurance.

Enrollment & Coverage Dates

You may be able to enroll in a 2019 health insurance plan outside of Open Enrollment if you qualify for a Special Enrollment Period. A Special Enrollment Period is a time outside of the Open Enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. If you don’t have a special enrollment period, you can’t buy insurance through the Marketplace until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 60 days.

To find out if you qualify for a Special Enrollment Period, please go to the following website, https://www.healthcare.gov/glossary/special-enrollment-period/, call CMS at 1-800-318-2596, or you may call Vantage’s Member Services department toll-free at (844) 833-7505, Monday – Friday, 8:00 a.m. - 8:00 p.m. for assistance.

Open Enrollment for 2020 coverage will be in the Fall of 2019.

Few Helpful Steps

A few helpful steps you can take to help prepare before getting started with the Marketplace:

  • Learn about different types of health insurance
  • Make a list of questions you have before it’s time to choose your health plan
  • Make sure you understand how insurance works, a few examples include:
    • Deductibles
    • Out-of-pocket maximums
    • Co-insurance
    • Co-payments
  • Start gathering basic information about your household income
  • Set your health insurance budget (affordable premium payment)
  • Find out from your employer whether they plan to offer health insurance
  • Explore your current options. (You may be able to obtain insurance through existing programs.)

NOTE: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, you may lose the employer contribution (if any) to the employer-offered coverage. Also, the employer contribution, as well as your employee contribution to employer-offered coverage, is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace will be made on an after-tax basis. You may want to consult your tax advisor on the income tax consequences of obtaining coverage through the Marketplace.

Vantage Health Plan, Inc., Insurance  Health, Monroe, LA