Health Market USA: What is it and how to buy?

The federal government operates the Health Market in the USA (Health Insurance Marketplace), a service that helps people shop for and enroll in health insurance. However, some states have their own health insurance marketplaces.

The Affordable Care Act (ACA) established the marketplace as a means of achieving maximum compliance with the mandate that all Americans have some form of health insurance.

The Health Insurance Marketplace (known as a “Marketplace” or “exchange”) offers help with purchasing and enrolling in health plans through websites, call centers, and in person.

Small businesses can use the Small Business Health Options Marketplace (SHOP) to provide health insurance to their employees.

When applying for individual and family coverage through the Health market in the United States, you must provide information about your income and your household. You’ll find out if you qualify for:

  • Premium tax credits or other savings that make insurance more affordable.
  • Coverage through the Children’s Health Insurance Program (CHIP) and Medicaid in your state.

Health Market in the USA

Who can buy in the Health Market in the United States?

If you and your family don’t have health insurance through your employer, you can choose a plan at US health insurance market and pay it by yourself.

If you are self-employed or unemployed, you should search among the health policies that are available in the market to choose the one that best suits your needs. If your employer offers health insurance coverage, you can also buy it in the Marketplace, but you’ll have to pay the full price of your plan.

To shop at healthcare market in the United States You must be a US citizen and live in the United States. Please note that if you qualify for Medicare, you are not eligible to shop in the Marketplace. Incarcerated people are also not eligible.

When can I buy a plan in the Health Marketplace in the United States?

Health insurance can be purchased during the open period or open enrollment. For example, open enrollment for 2021 begins on November 1, 2020 and ends on December 15, 2020. However, there is a special enrollment period which is available for 60 days after certain life changes (qualifying events), such as marriage, moving, or the birth of a baby.

Events that qualify for a Special Enrollment Period

Changes in household size

You may qualify for a Special Enrollment Period if you or someone in your household in the last 60 days:

  • Married: choose a plan on the last day of the month and coverage may begin the first day of the following month.
  • Had a baby, adopted a child, or placed a child in foster care. Coverage can start the same day as the event (even if you sign up up to 60 days later).
  • Got divorced and lost health insurance. Note: Divorce or legal separation without loss of coverage does not qualify for a Special Enrollment Period.
  • He died: You’ll be eligible for a Special Enrollment Period if someone on your plan dies and you’re no longer eligible for your current health plan.

Changes of residence

Below you will find the address changes that qualify you for a Special Enrollment Period:

  • If you move to the United States from abroad
  • If you move to a different county or zip code
  • If you are a student and you move to or from the place where you go to school
  • If you move to or from where you live and work as a temporary worker
  • If you are moving to or from shelter or other transitional housing

IMPORTANT: Moving just for medical treatment or to stay at a vacation spot does not qualify you for a Special Enrollment Period.

Remember that you must confirm that you had qualified for medical coverage for one or more days during the 60 days before the move. Confirmation is not required if you are moving from a foreign country or US territory.

Loss of health coverage

You may qualify for a Special Enrollment Period if you lost your qualifying coverage in the last 60 days (or more than 60 days but since January 1). Or if someone in your household loses coverage in the next 60 days.

Losses of coverage that may qualify you for a Special Enrollment Period:

  • Losing eligibility for Medicaid or CHIP
  • Losing coverage through employment
  • Losing individual health coverage under a plan or policy you purchased
  • Losing qualifying health coverage through a family member

Help from your employer with the cost of coverage

You may qualify for a Special Enrollment Period if you or anyone in your household gained access to an individual coverage HRA or an agreement to reimburse medical expenses for Qualified Small Employers in the last 60 days or in the next 60 days.

Note: To refer to an individual coverage HRA, your employer may use a different name, such as the acronym “ICHRA.”

Generally, you must enroll in individual health insurance before your individual HRA or QSEHRA coverage begins. However, your employer may offer different options to start your individual HRA or QSEHRA coverage, so you have more time to enroll. We recommend that you contact them or review the notice you received from your employer for more information.

Remember that If you’re currently enrolled in a Health Marketplace plan with savings, savings may vary based on help you get through a job.

Other life changes you may qualify for

There are also other life changes that may qualify for a Special Enrollment Period. For example:

  • Obtain status as a member of a federally recognized tribe or Alaska Native (ANCSA).
  • be released from jail
  • Become a United States Citizen.
  • Be a member of state and national AmeriCorps, VISTA, or NCCC and beginning or ending service.

IMPORTANT: Be prepared to confirm your information. When you apply, you certify that the information is true, including the events that qualify you for a Special Enrollment Period. You will be asked to submit documents to confirm that you qualify to enroll based on your life event.

What types of health insurance are available in the Marketplace?

There are four types or levels of health plans available: Bronze, Silver, Gold and Platinum. Coverage for medical bills will be different depending on each tier. You must also bear a portion of the costs through the monthly premium, copays, deductible, and coinsurance. The amount you must assume will depend on your plan.

The right plan for each person will depend on their own situation.

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