Health Insurance in the Open Market

Navigating the Health Insurance Marketplace

If you are in the United States and do not have health insurance through an employer, you can purchase health insurance through the Health Insurance Marketplace. The Marketplace is a government-run website where you can compare plans and prices from different insurance companies.

To enroll in a Marketplace plan, you must meet certain eligibility requirements, such as being a U.S. citizen or legal resident and not being incarcerated. You can also enroll if you have a low income or if you experience a qualifying life event, such as losing your job or getting married.

Once you are eligible, you can apply for a Marketplace plan online, by phone, or through a paper application. You will need to provide information about your income, family size, and health status.

If you qualify for a subsidy, you will receive a tax credit that will lower your monthly premium costs. The amount of the subsidy you receive will depend on your income and family size.

Types of Health Insurance Plans

There are four main types of health insurance plans available through the Marketplace:

Bronze plans have the lowest monthly premiums but the highest deductibles and out-of-pocket costs.
Silver plans have higher monthly premiums than Bronze plans, but lower deductibles and out-of-pocket costs.
Gold plans have the highest monthly premiums but the lowest deductibles and out-of-pocket costs.
Platinum plans have the highest monthly premiums and the lowest deductibles and out-of-pocket costs.

Choosing a Health Insurance Plan

When choosing a health insurance plan, it is important to consider your needs and budget. If you are healthy and do not expect to use your insurance very often, you may want to choose a Bronze plan. If you have a chronic condition or expect to use your insurance frequently, you may want to choose a Silver, Gold, or Platinum plan.

You should also consider the following factors when choosing a health insurance plan:

Network size: The network size refers to the number of doctors and hospitals that are covered by the plan. A larger network size means that you will have more choices for providers.
Deductible: The deductible is the amount of money you must pay out-of-pocket before your insurance coverage begins. A higher deductible will lower your monthly premium costs, but it will also mean that you will have to pay more for medical care before your insurance kicks in.
Coinsurance: Coinsurance is the percentage of the cost of medical care that you must pay out-of-pocket after you have met your deductible. A higher coinsurance percentage will lower your monthly premium costs, but it will also mean that you will have to pay more for medical care.
Out-of-pocket maximum: The out-of-pocket maximum is the most you will have to pay for medical care in a given year. Once you reach your out-of-pocket maximum, your insurance will cover 100% of the cost of medical care for the rest of the year.

Getting Help

If you need help choosing a health insurance plan, you can contact a health insurance agent or broker. Agents and brokers can help you compare plans and prices and find the best plan for your needs. You can also get help from the Marketplace website or by calling the Marketplace call center at 1-800-318-2596.