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Marketplace Health Insurance (ACA)

The 2024 Marketplace Open Enrollment Period (OEP) for states using the HealthCare.gov platform runs from November 1, 2023, to January 16, 2024. This period allows individuals and families to enroll in or change their health coverage options that are available on The Marketplace. 

To get coverage starting January 1, 2024, you will need to sign up by December 15, 2023. 

During Open Enrollment, you can renew, change, or update your plan. 

Outside of these time windows you are only allowed to Enroll in a Marketplace Plan if you have a Qualified Life Event (QLE). This period is called a Special Enrollment Period (SEP). A QLE is a change in your life situation that makes you eligible to enroll in health insurance outside of the annual Open Enrollment Period. The IRS states that a qualifying event must have an impact on your insurance needs or change what health insurance plans that you qualify for. 

Some examples of qualifying life events include: 

  • Getting married
  • Getting divorced
  • Having or adopting a baby
  • Death of someone who shares your health plan
  • Moving to a new area
  • Earning U.S. citizenship
  • Turning 26
  • Turning 65
  • Losing health coverage

Are you looking for Health Insurance from the Marketplace and would like some free guidance and assistance in enrollment?

 Contact Us for a Free Consultation!

Or Click FIND MY ACA PLAN to get started and find out more information on choices available to you, so you can have some financial protection when a medical event happens to you or your family.

States We Currently Serve:

Washington, Arizona, Texas, Oklahoma, Michigan, Ohio, Tennessee, South Carolina, Florida

If you want to learn more about all the nuances of The Marketplace, keep reading.

The Federally Facilitated Marketplace (FFM) is an online marketplace where individuals & families can purchase health insurance plans. The FFM is operated by the Centers for Medicare & Medicaid Services (CMS) in accordance with federal standards.

The FFM is also known as the “Marketplace” or “Exchange”. It allows individuals to browse, compare, and purchase health insurance plans available under the Affordable Care Act, also known as “Obamacare”. 

To be eligible to use the Marketplace, you must: 

If you have Medicare coverage, you can’t enroll in a Marketplace health or dental plan. Learn more about Medicare and the Marketplace.

You can also Click Here to Talk to a Medicare Expert about your Medicare Options

For Marketplace Options you can apply for and enroll in coverage through HealthCare.gov You can also contact the Health Insurance Marketplace by telephone, 24 hours a day, 7 days a week at 1-800-318-2596 (TTY: 1-855-889-4325)

Some of this might make your head spin, so It also may help to work with a Health Insurance Advisor (agent / producer / broker) who is Licensed in your state to help walk you through the process as it can be confusing as to what information & documentation you may need and what options to choose to protect you and your family. The Licensed Advisor will not charge you for their services. They help you choose your core health plan and any supplemental health plans that suit your needs and your budget.

More than half the states use The Federal Facilitated Marketplace (FFM) through HealthCare.gov but about 20 states have their own State Based Exchange where consumers can apply for and enroll in health insurance.

Marketplace Health Insurance refers to health insurance plans that are offered under the Affordable Care Act (ACA), also known as Obamacare. The Affordable Care Act, enacted in 2010 in the United States, aimed to make health insurance more accessible and “affordable” for a larger portion of the population.

Key features of ACA health insurance include:

  1. Essential Health Benefits (EHB): ACA-compliant plans are required to cover a set of essential health benefits, ensuring that policyholders have access to a range of necessary healthcare services. These benefits include preventive services, prescription drugs, maternity care, mental health services, and more. You may not need or want some of these services, but you still pay for them and they are there for you to access under these plans.
  2. Pre-existing Conditions: ACA plans are prohibited from denying coverage or charging higher premiums based on pre-existing conditions. This provision ensures that individuals with pre-existing health conditions cannot be discriminated against when seeking health insurance. This is what is called Guaranteed Issue Health Insurance, which means there is No Medical Underwriting like there is in some Off Marketplace Plans, which might offer less expensive (Zero Deductible) and possibly more robust benefits if you do medically qualify.
  3. Premium Subsidies: The ACA Plan you choose, may provide a couple of subsidies (Advance Premium Tax Credit – APTC and Cost Sharing Reduction – CSR) to eligible individuals and families with low to moderate incomes to help reduce health insurance premiums, deductibles or out of pocket expenses. These subsidies are designed to lower the out-of-pocket costs for those who qualify. This credit can move up or down each year if your income changes. If you earn more money, you get less subsidy, if you earn less money you get more subsidy. If your income moves up inside a policy year, it is best to report that change (at least Quarterly) on your HealthCare.gov account so your insurance premium will adjust accordingly, otherwise you will be required to pay any overpaid subsidy back to the government, when you file your taxes.
  4. Individual Mandate (No Longer in Effect): The ACA initially included an individual mandate, which required most Americans to have health insurance coverage or face a penalty on their taxes. However, the penalty for not having insurance was reduced to $0 starting in 2019 in most states, effectively eliminating the individual mandate in most states.
  5. Marketplace Exchanges: ACA health insurance plans are typically purchased through the Health Insurance Marketplace, also known as the Exchange. The Marketplace allows individuals to compare different plans and choose the one that best fits their needs and budget. This exchange for most states is on HealthCare.gov but some states have their own State Based Exchange like Washington State. You can also work with a Licensed Advisor in your state and they can assist you in the exchange.
  6. Medicaid Expansion: The ACA aimed to expand Medicaid eligibility in participating states, allowing more low-income individuals and families to qualify for this government-funded healthcare program.

It’s important to note that specific details and regulations related to ACA health insurance can vary in each state. Individuals seeking coverage should explore the options available in their state’s Health Insurance Marketplace and consider their own healthcare needs and financial circumstances when selecting a plan and talking with an advisor is also recommended.

In our opinion, ACA Health Insurance plans aren’t perfect or even the best or least expensive solution for everyone, but when individuals or families are low income and / or have pre-existing health conditions that need day 1 coverage then ACA Compliant plans may be the only choice. The only “health condition” ACA plans rate up are Tobacco use, which raises your rates by about 50%. But, there are no health conditions that will disqualify you from getting an ACA plan.

Luckily the penalty for NOT having a marketplace plan is not longer an issue so if you’re healthy and are ok with not receiving any subsidy you may get from the marketplace, in most states, there are some really comprehensive core health plans available with that offer 1st Dollar Coverage National Network PPO’s.

There are some downsides to having an ACA plan, which again for various reasons, may be your only choice for your Core Health Plan. These downsides include; most of the plans are HMO or EPO’s which means your network is limited, sometimes down to certain counties and most of the time limited to your resident state. Not so great if you travel or you want to see a specialist in another state. Also, most of these ACA plans, even if they include a subsidy to lower the premium, still have very high deductibles that need to be met before your insurance kicks in and will likely still have a high co-insurance (20%-50% in most cases) until you meet your large Max Out of Pocket Expense (MOOP) for each policy year.

What this means is, for the most part, anything beyond preventative care (which you are likely still paying co-pays for that don’t count towards your deductible or MOOP), before your Core Health Plan kicks in, you will have to pay upwards to $9450 (ACA MOOP for 2024) for individuals or double that for couples/families if you end up needing any hospital, sickness, injury or specialty care and good luck if you need it while traveling out of state unless it’s a life or death situation.

So IF an ACA plan is your only choice for your Core Health Plan, it’s always a good idea talk to a Licensed Health Insurance Advisor about padding your core plan with a supplemental plan (or two or three) that would take care of your deductible, co-Insurance and other out of pocket expenses when something medically does happen. The Best Insurance plan always includes supplementals. Depending on your State and Situation, there’s typically not a 1 plan Comprehensive Solution out there that covers everything. To protect you from high costs of the medical system (even when you’re in network) you will want to have multiple insurance policies that work together and serve different purposes.

To keep catastrophic costs down, you will want supplemental plans to fill the gap and cover the deductibles, co-insurance and other out of pocket expenses related to medical events.

So for example, maybe at the very least you have an Accident plan that has a $10,000 benefit. If you have an accident your Accident Insurance will cover the high deductible on your main ACA plan and then the main plan will kick in and cover the remaining hospital bill and anything else for the rest of the year. Accident plans aren’t too expensive and so it’s a good supplemental plan to have on board.

The next supplemental we recommend is hospital indemnity. This is in case you end up sick and need to be admitted to the hospital (Accident Plans only cover accidents NOT sickness). These are usually fixed benefits for various services and procedures (Hospital, Ambulance, Surgery, Outpatient, ER etc.) that will help cover your deductible so your ACA plan will then kick in and take over.

You could also consider having a Critical Illness plan that would cover more serious stuff like heart attack, stroke or cancer and would pay out bigger lump sums (usually $25K-100K) directly to you. This is good because if you’re out of work recovering you can have cash to pay the bills and focus on your recovery.

There’s also Dental, Vision & Hearing Plans that may be necessary. We recommend everyone should have a dental plan for general maintenance but especially if you have children you can consider a comprehensive plan that includes orthodontics or if you’re older maybe a plan that covers implants or other prosthetics.

No matter what we recommend talking to a qualified and trusted Licensed Health Insurance Advisor to walk you through the process and help guide you in picking the right ACA & Supplemental Plans that fit your needs and your budget.

Send us a message

Or Click FIND MY ACA PLAN to get started and find out more information on choices available to you, so you can have some financial protection when a medical event happens to you or your family.

States We Currently Serve:

Washington, Arizona, Texas, Oklahoma, Michigan, Ohio, Tennessee, South Carolina, Florida

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