A quick guide to the Health Insurance Marketplace ®

A federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Refer to glossary for more details.

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels.

Refer to glossary for more details.

Children's Health Insurance Program (CHIP)

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women.

Refer to glossary for more details.

, or another source that provides qualifying health coverage

Any health insurance that meets the Affordable Care Act requirement for coverage. The fee for not having health insurance no longer applies. This means you no longer pay a tax penalty for not having health coverage.

Refer to glossary for more details.

, you can find coverage through the Marketplace. Who can get Marketplace coverage?

1. Open Enrollment is November 1-January 15

2. Outside the yearly Open Enrollment, you can get coverage or change plans only if you:

Special Enrollment Period

A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount. Refer to glossary for more details.

3. Most people qualify for savings

Depending on your expected household income for the year, you may qualify for: premium tax credit

A tax credit you can use to lower your monthly insurance payment (called your “premium”) when you enroll in a plan through the Health Insurance Marketplace®. Your tax credit is based on the income estimate and household information you put on your Marketplace application. Refer to glossary for more details.

that lowers your monthly plan premium, and for extra savings

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings. Refer to glossary for more details.

on out-of-pocket costs like deductibles

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. Refer to glossary for more details.

copayments

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible. Refer to glossary for more details.

coinsurance

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. Refer to glossary for more details.

4. All Marketplace plans cover:

The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Refer to glossary for more details.

5. You can apply for coverage several ways

Apply any way that works for you: Use this checklist to gather what you’ll need to complete your application (PDF, 184 KB).

6. Don't forget to pay your monthly premium

When you have Marketplace insurance, you'll pay your monthly premiums directly to the insurance company — not to the Marketplace. Your coverage won't start until you pay your first premium. Get more information on completing your enrollment.

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