What is the ACA Health Insurance Marketplace?
The Health Insurance Marketplace is a platform that offers insurance plans for individuals, families, and small businesses. The Affordable Care Act (ACA) established the marketplace as a way to extend health insurance coverage to millions of uninsured Americans. Many states offer their own markets, while the federal government operates an exchange open to residents of other states.
Understanding the ACA Health Insurance Marketplace
The health insurance marketplace is a key component of the Affordable Care Act, a healthcare reform that President Barack Obama signed into law in 2010, also known as Obamacare. The law instructed states to establish their own exchanges where uninsured individuals or families could Sponsor Comparative Business Plans. However, many states chose not to create a market and joined the Federal Stock Exchange.
The marketplace facilitates competition between private insurers in a central location where people without access to employer-sponsored insurance can find a suitable plan. People can compare plans and apply through the Marketplace during open enrollment. Typically, this period occurs in November and December of the year prior to the year in which coverage will become effective. Consumers can request a special registration period in the event of a qualifying event, such as the birth of a child, marriage, or the loss of another insurance plan.
The market ranks the plans in four levels: Bronze, Silver, Gold and Platinum, in order from lowest to highest. The highest tier, Platinum, includes plans that cover almost 90% of health expenses, but are also the most expensive. Low-income individuals and families may qualify for additional savings on all health insurance plans offered in exchange through premium tax credits and cost-sharing reductions.
ACA Health Insurance Marketplace Requirements
The health insurance marketplace has requirements for the individuals and families who use it, as well as for the insurance companies that provide coverage. To be eligible to purchase Marketplace coverage, you must live in the United States and be a US citizen or citizen. If you are covered by Medicare, you are not eligible.
While the plans offered by insurance companies in the marketplace can vary widely, the ACA requires that each meet the basic requirements or Essential Health Benefits (EHB). Many EHBs may seem like it goes without saying, but plans may skimp on basic coverage and some political opponents of the ACA have proposed eliminating EHBs since the passage of the ACA.
Required benefits include:
- Outpatient Services
- Emergency services
- Hospital treatment
- Laboratory services
- Mental health and substance use disorder services
- Care during pregnancy, maternity and newborn
- Drug prescriptions
- Preventive and wellness services and chronic disease management
- Pediatric services
- Rehabilitation and rehabilitation services
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