What are Health Insurance Marketplace Plans?

Few things in life are more important than health insurance. Sadly, most of us find the process of obtaining and using health insurance overwhelming. “Do I need health insurance?” is an important question to consider as the Annual Enrollment Period (AEP) draws near. The AEP enrollment period for most states runs from November 1 through December 15, though certain conditions may decide to extend it.

What is the individual health insurance marketplace?

The health insurance marketplace is a widely accessible online “store” where you can look for individual and family health insurance policies in your state. 

Using our purchasing portal, you may compare numerous health plans’ costs, features, and advantages. Additionally, other insurers are offering a variety of plans to suit various demands and price ranges, making it an “actual” marketplace.

Is Obamacare the same as marketplace insurance?

Yes! A federal health insurance marketplace was made possible by the Affordable Care Act (or ACA), which was signed into law in 2010. (The act was signed into law by President Barack Obama; hence, the moniker, “Obamacare”). 

Since then, 14 states have created their own marketplaces, known as individual health insurance marketplace. All medical insurance plans must also be ACA-compliant, which means they must include ten essential health benefits to plan members, whether offered on a federal marketplace or a state-specific exchange.

The goal of the law—also referred to as “The Patient Protection and Affordable Care Act”—is to increase access to high-quality healthcare for more Americans.

What are the types of insurance plans that are available in the marketplace?

Plans are divided into four categories in the health insurance market: Bronze, Silver, Gold, and Platinum.   

The costs of each plan, including premiums, copays, deductibles, and coinsurance, are categorized by these metal levels. The most expensive premium will be associated with a Platinum level plan. Although they are more costly than other plans available, these Platinum plans will cover the majority (about 90%) of your medical expenses. Gold plans cover about 80% of your costs, Silver plans 70% and Bronze plans 60% of your healthcare costs. The key is finding the correct cost-to-coverage ratio that makes sense for your level of care needs and your financial capabilities. 

Remember: These prices represent the price of each plan, NOT the standard of care you will receive. You won’t necessarily get better care if you choose a higher metal level plan.

Is there any available financial help through the marketplace?

You might be qualified for financial help to help cover the cost of your health insurance. Your household size and annual income will determine the amount of assistance you receive. Your monthly premium, the cost of your care, or both may be reduced. You can learn more about possible financial assistance while completing the application process.

Who is eligible for the Health Insurance Marketplace?

There are a few (very significant) conditions you must meet before you can shop in the market:

  • You must live in the United States.
  • You must be a lawful permanent resident, a citizen, or a national of the United States. 
  • You cannot be imprisoned (serving time in jail or prison) 
  • You should not be a Medicare beneficiary. 

Do I need to use the health insurance marketplace? 

It depends. First, if you are currently employed, determine whether the plans provided by your employer are both inexpensive and adequate for your current medical requirements. If so, sticking with the options offered by your employer will probably be simpler. If not, it would be wise to see what is available in the market. 

Second, the marketplace is an excellent choice if you can’t find an inexpensive plan, are ineligible for a state program like Medicaid, and are unemployed or disabled. 

Third, the health insurance market is unquestionably the best place for you if you’re self-employed, especially since you’ll have many competitive options from various insurers in one location.


Q: How do I enroll in a Health Insurance Marketplace Plan?

A: You can enroll in a Health Insurance Marketplace Plan during the open enrollment period, which typically runs from November 1 to December 15 of each year. You can also enroll in a plan during a special enrollment period if you experience a qualifying life event, such as losing your job-based health insurance or getting married.

Q: How are Health Insurance Marketplace Plans different from other types of health insurance?

A: Health Insurance Marketplace Plans are sold through the Health Insurance Marketplace, which means they are subject to certain rules and regulations established by the ACA. These plans must cover a set of essential health benefits, including preventive care, hospitalization, and prescription drugs. They also cannot charge more or deny coverage based on pre-existing conditions. In addition, many people who buy Marketplace plans are eligible for financial assistance to help pay for their premiums and out-of-pocket costs.

Q: How much do Health Insurance Marketplace Plans cost?

A: The cost of Health Insurance Marketplace Plans varies based on several factors, including your age, location, and income. However, many people who buy Marketplace plans are eligible for premium tax credits and cost-sharing reductions, which can lower the cost of coverage. You can use the Health Insurance Marketplace to compare plans and costs.

Need help in choosing a Marketplace plan?

Millions of Americans have improved access to coverage thanks to the health insurance marketplace. However, there are many aspects and terminology to understand. How can you be confident you’ve chosen the right insurance for your health and budget while still getting the coverage you need?

Don’t worry! We would be more than happy to guide you through the process of learning about, enrolling in and utilizing a health insurance plan through the Marketplace. Health Plans in Oregon has the knowledge and expertise to help make things simple. Call us at 503-928-6918. Our assistance is at no cost to you. 

*By completing this form, you agree that an authorized representative or licensed insurance agent may contact you by phone,email,text, mail or face to face to answer your questions or provide additional information about your Medicare plan options. Not affiliated or endorsed by Medicare or any state or federal governmental agency.

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