A quick guide to the Health Insurance Marketplace^®

Tips about the Health Insurance Marketplace®

1. Open Enrollment is November 1-January 15

• Enroll by December 15 for coverage that starts January 1
• Enroll by January 15 for coverage that starts February 1

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

• Have a life change or income that qualifies for a
  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.

  .
• Qualify for Medicaid or the Children's Health Insurance Program (CHIP). You can enroll any time of year and coverage can start immediately. Learn more about these programs.

3. Most people qualify for savings

• Lower costs for your Marketplace plan, like the 
  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.

  , and
  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.

  . 
• Coverage through Medicaid or CHIP. Your children may qualify for CHIP, even if you don't qualify for Medicaid.

4. All Marketplace plans cover:

• 10 essential health benefits, including prescription drugs, emergency services, hospitalization, laboratory services, and mental health and substance use disorder services
• Free preventive health services at no cost to you when delivered by a doctor or provider in your plan's
  network

  The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

  Refer to glossary for more details.

• Coverage for pre-existing conditions

5. You can apply for coverage several ways

• Online
• By phone
• With the help of someone in your community
• Through an agent/ broker
• Through certified enrollment partner websites
• With a paper application

6. Don't forget to pay your monthly premium