Here’s a quick rundown on the most important things to know about the Health Insurance Marketplace, sometimes known as the health insurance “exchange.” Follow the links for more information on each topic.
Important. Marketplace Open Enrollment ended March 31 2014. You can still buy a Marketplace health plan only if you qualify for a special enrollment period. You can apply for Medicaid and CHIP any time. Find out if you qualify for a Special Enrollment Period or Medicaid and CHIP. Open Enrollment for 2015 coverage started November 15, 2014.
The Health Insurance Marketplace helps uninsured people find health coverage. Fill out a Marketplace application and we’ll tell you if you qualify for:
- Private health insurance. Plans cover essential health benefits, pre-existing conditions, and preventive care. Some plans include dental coverage. In other cases, free-standing dental plans are available.
- Lower costs based on your household size and income. You can preview plans available in your area right now, with prices based on your income and household size. Most people who apply will qualify for lower costs.
- Medicaid and the Children’s Health Insurance Program (CHIP). These programs cover millions of families with limited income. If it looks like you qualify, we’ll share information with your state agency and they’ll contact you. Many but not all states are expanding Medicaid to cover more people. Find out what Medicaid expansion means for you.
Most people are eligible to use the Marketplace.
Most people must have health coverage or pay a penalty. If you don’t have coverage in 2014, you’ll pay a fee of either 1% of your income, or $95 per adult ($47.50 per child), whichever is higher. You'll pay the fee on your 2015 income taxes.
Some people qualify for an exemption from the fee, based on income or other factors.
You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.
You can also buy a plan outside the Marketplace and still be considered covered. If you buy outside the Marketplace, you won’t be eligible for premium tax credits or lower out-of-pocket costs based on your income.
If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance isn't considered affordable or doesn’t meet minimum requirements.
If you have Medicare, you’re considered covered and don’t have to make any changes. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan.