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How to Use the Health Insurance Marketplace

Jared is a former college professor and financial advisor. He has published dozens of articles on job outlooks for various professions.


How to Use the Health Insurance Marketplace

If you are planning to purchase an insurance policy through the Marketplace, you should know that there are many private health insurance companies to choose from. These companies include Blue Cross, Cigna, and UnitedHealthcare. Each of them offers a different type of health insurance plan and has different level of coverage. The level of coverage determines the premium and out-of-pocket cost. The marketplace is a central location that allows various private insurers to offer plans for a wide variety of budgets.

Special Enrollment Periods

There are many reasons to enroll in a health insurance plan during the special enrollment period on the Health Insurance Marketplace (HIM). These can include a job change, a new family member, or any qualifying life event. In some cases, these events can trigger a special enrollment period and lower your monthly premium bill. Generally, you can enroll in a plan if you are eligible for a subsidy, also known as a premium tax credit.

Whether you're changing jobs or relocating to a new state, you'll want to check the specifics. Some special enrollment periods are for people who are relocating for a job or to get married. Those who are getting married can pick a new plan that begins the day after their wedding, and those who are losing coverage can do so retroactively. If you're moving from a foreign country to the U.S., you'll need to provide proof that you had qualifying health coverage within 60 days. If you've lost health insurance coverage within 60 days of your move, you can apply for a new plan during a Special Enrollment Period.

If you're a victim of domestic abuse, spousal abandonment, or other qualifying life events, you can enroll in your own health insurance plan through the Health Insurance Marketplace. During the SEP, you'll have 60 days to submit the necessary paperwork and choose a plan. Your coverage will start on the first day of the month after you select a plan and pay the premiums. But, if you don't get a notification within 60 days of enrolling in a Marketplace plan, you'll have to wait until the OEP.

You can also enroll in an individual health insurance plan during a special enrollment period if you're experiencing one of the qualifying life events listed above. These special enrollment periods generally last 60 days after the qualifying life event, and you can enroll in any plan during this time period. Some special enrollment periods are for people undergoing a qualifying event, like a new job, or an adoption. These special enrollment periods may be limited to a certain population.

Cost-sharing reductions

Premium tax credits, or subsides, can lower the cost of your health insurance plan. The federal poverty level changes every year, and the amount you qualify for will change each year, as well. Because premium subsidies are tax credits, they can be claimed in advance. However, they must be reconciled with the premium subsides you receive when you file your taxes. This means that if you receive a subside, but do not use it, you may have to pay it back to the IRS.

To qualify for a cost-sharing reduction, you must have an eligible plan. For Silver plans, this is the first type of plan that is available. The lower the copayment, the less money you will have to spend on care. In this example, if John has a high income, he could qualify for a cost-sharing reduction of 15% and pay $15 instead of $30 for a doctor's visit.

While there are exceptions, there are some common patterns. The same person can receive a cost-sharing reduction on a silver plan with a high deductible and then move down to a standard silver plan without it. On the other hand, if the person changes his or her income, he or she can switch to a plan with a lower cost-sharing reduction or even a more generous cost-sharing reduction. In these cases, the cost-sharing reductions that have been received are not refundable, so the person can't get a refund for prior costs.

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As mentioned, cost-sharing reductions are subsides that help low-income people purchase health insurance. They also lower the out-of-pocket maximums and increase the actuarial value of health plans. Cost-sharing reductions are also available for people with low income who qualify for premium tax credits. The criteria for receiving premium tax credits vary by income level and household size. The most generous subsides are for those with incomes up to 150% FPL. In addition, CSR 94 plans are similar to platinum and silver plans.

Cost-sharing reductions when using the Healthinsurance Marketplace are available to people with low incomes and a high premium. However, people with a low income should opt for a silver plan and take advantage of the cost-sharing reductions that the exchange offers. Those with lower incomes should opt for silver plans because the cost-sharing amounts will be less. If their income is more, they can opt for a gold plan and save money.

Premium tax credits

Premium tax credits can lower your monthly marketplace premiums. These credits are calculated based on the amount of income that your household earned in the tax year you paid for your health insurance. Typically, premium tax credits are sent to the health insurance company in advance of the filing season. You receive a reduction in premiums and pay your insurer less. However, you must pay back any excess premium tax credits on your income tax return.

If you receive a tax refund for the year, the premium tax credit will be applied to that money. Using this option can mean a huge tax refund. However, the premium tax credit does not cover the cost of the remaining bill. Therefore, you may have to pay a higher amount each month or pay less in advance, but in the end, it will be even. However, if you are short on cash and do not want to carry a higher health insurance premium than your income allows, it is best to use the advance payment option.

If your income changes, you should immediately report this change to the marketplace. If your income increases, you may be eligible for a higher advance payment of premium tax credits. Similarly, if you increase your family size, you may receive more cost sharing help. Be sure to report any changes so you don't end up paying back too much of your advance payment. For these reasons, it is vital that you follow the guidelines set by the marketplace.

If you are considering changing your health insurance plan, remember that you have until May 15 to enroll. If you are currently enrolled in an insurance plan, however, it is a good idea to look at the cost before making a decision. Take into consideration how much money you have paid toward your deductible as it might be reset when you switch plans. If you don't, you'll have to start over paying out of pocket expenses to reach your deductible.

Transferring your information to the appropriate agency

If you are using the Health Insurance Marketplace, you can request copies of your personally identifiable information. You can also question whether the information you provided is accurate and request an accounting of disclosures. You may also request to receive a copy of this notice. If you are concerned about these practices, you should read the System of Records Notice. It will explain how your information is used and shared. Further, you should have a copy of the notice so that you can make an informed decision on whether to use the Health Insurance Marketplace.

In some cases, you will need to provide certain information in order to qualify for the marketplace's affordability programs. You will be asked to verify your employment information, citizenship status, and income. If you want help paying for health insurance, you will be asked about your current income and employment. Moreover, you will be asked to verify whether you are enrolled in any health coverage in the past year. In addition, each application filer agrees to share their information with the Marketplace. Additionally, federal and state agencies may request information that you provide for the appeal process. For instance, if you are a U.S. citizen, you may be asked to provide a copy of your birth certificate.

This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.

© 2022 Jared Lewis

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