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Who Can Buy Insurance On The Exchange


Open enrollment is the period within the year that people can enroll in a health insurance plan. Open enrollment for the Health Insurance Marketplace runs annually from early November to mid-December, with coverage starting in the New Year. In 2021, You can enroll in Marketplace health coverage February 15 through May 15 due to the coronavirus disease 2019 (COVID-19) emergency.

If you buy your health insurance on the individual marketplace, there are basically two kinds of polices you can consider for yourself and your family: on-exchange policies and off-exchange policies. Each option has its own unique benefits that should be considered the next time you are ready to shop. Read on to learn the differences between the two and discover which choice could be the right fit for the coverage you need.

The original health insurance marketplace started as the federal Health Insurance Marketplace - a website where individuals could shop for various health care plans available under the Affordable Care Act (ACA), often referred to in earlier years as Obamacare, beginning in 2010. Since that time, 14 states have developed their own individual health insurance exchanges, aka marketplaces. All medical insurance plans sold on the public marketplace must be ACA-compliant, meaning they must cover 10 essential health benefits for consumers.

Off-exchange health insurance is a plan that is purchased directly from an insurance provider, or through a broker. This is outside of your state's health insurance marketplace or outside of, aka the exchange. Though these are considered private plans, they also fall all under ACA compliance, which ensures minimum coverage and essential health benefits.

A primary benefit of purchasing health insurance from an insurance provider is that you have a more first-hand expertise with the plans they offer and they can break down even more details and differences in their offerings. Sometimes, insurance providers may offer more options than their plans that are available on the exchange. Additionally, you can enjoy the simplicity of direct enrollment with an agent rather than a less direct online portal that connects with the insurance company.

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed Send it to We may use it in a future on-air or online segment.

It's an online marketplace where individuals and small employers can shop for insurance coverage. Enrollment began Oct. 1 for policies that will go into effect on Jan. 1. The exchanges will also help people find out if they are eligible for federal subsidies to help cover the cost of coverage or if they are eligible for Medicaid, the federal-state health insurance program for the poor.

You can enroll until March 31, 2014, though you'll need to sign up and pay your first premium by Dec. 15 of this year if you want to be covered when the mandate to carry health insurance kicks in on Jan. 1. If you sign up and pay premium between Dec. 16 and Jan. 15, 2014 - coverage starts on February 1.

Yes. Sixteen states and the District of Columbia are running their own exchanges and the federal government is setting them up in 27 states. In seven states, federal and state officials are partnering to run the exchanges. You can get information about the exchange at, which has details on the federal exchanges and links to state-run exchanges.

Some people do, but definitely not everyone. These exchanges are for two major groups of people: Those who don't have insurance now, and those who currently purchase their own insurance, meaning they don't get it through an employer.

If you have insurance at your job or through a public program like Medicare, Medicaid or the VA, you don't need to pay attention to the exchanges unless you lose that coverage for some reason. If you have insurance through your employer, you can shop for and buy insurance on an exchange if you like, but you probably won't qualify for a subsidy or tax credit. And you would lose the contribution your employer makes toward health insurance.

In theory, you can do it all or most of it online. You go to or to your state-run exchange, if there is one, and create an account. You provide some basic information, like where you live and how old you are and you'll get a list of plans available in your area. If you provide income information, you'll be able to get an estimate of whether you'll eligible for federal help paying for insurance or whether you might qualify for Medicaid.

The exchange will offer a list of health plans and their premiums and out-of-pocket costs, including deductibles and co-payments. If you decide to buy one of those plans, in most cases, you will be directed to the insurer's Web site to make the payment. Some plans or insurance companies may require a phone call to set up payment. In some jurisdictions, consumers will make their first premium payment to the exchange and then further monthly payments to the insurer.

The federal government has set up call centers to answer questions from people in states with federal exchanges. That phone number is 1-800-318-2596. States running their own exchanges also have individual call centers.

Most states have also trained people called assisters and navigators who can walk people through the process, although in some states the training for them has been delayed. Contact information can be found on the exchange websites.

No. You can't just sign up when you're sick and facing big medical bills. Otherwise that's what everyone would do. The exchanges under the Affordable Care Act have been designed pretty much the same way most employer insurance plans are: There's an open season every year when you can buy or change plans, and that's generally the only time you can buy or change plans.

No. Medicare is not part of the health insurance exchanges and Medigap policies are not being sold or subsidized through the exchanges. As a Medicare beneficiary, you can enroll at to get the program's traditional drug coverage or a Medicare Advantage plan, where Medicare enrollees get coverage through private health insurance plans. The Medicare open season begins Oct. 15.

If you are disabled and have no income, you most likely won't be shopping for insurance on the exchanges. Rather, you may qualify for Medicaid. In most states, if you qualify to collect Supplemental Security Income, or SSI, you also qualify for Medicaid. For more information on Medicaid eligibility and links to your state's Medicaid office, click here.

Most federal workers will continue to get their health coverage through the Federal Employees Health Benefits Program and not be required to purchase coverage through the health law's marketplaces. Members of Congress and their personal staffs, however, will be required to buy health insurance through the exchanges.

No, if you live abroad for at least 330 days within a 12-month period, you are not subject to the mandate to have health insurance. Insurance bought on the exchanges generally wouldn't cover you while overseas anyway (neither does Medicare, by the way). You'll need to find insurance that will cover you in the country where you live. The State Department keeps this list of companies that provide international coverage. For country-specific information, look here.

There are no requirements for employers with fewer than 50 workers to buy health insurance for their employees. Many small business do offer health care as a benefit, however, and for them, the insurance exchanges represent a new option for them in terms of where to shop.

If your income increases during the year, notify the exchange promptly so that you can avoid having to pay back the subsidy. On the other hand, if your income goes down, you could be eligible for a bigger subsidy. Either way it's important to notify the exchange if your income changes.

You won't have to pay more for insurance if you have a medical condition and that condition will be covered when your policy begins. But older people can be charged more than younger people and smokers face a surcharge.

You should carefully weigh the state of your health with your financial situation. For example, a person who's 27 and in excellent health may decide that the low premium and high deductibles of a Bronze or Silver plan are their best bet. Of course, an illness or accident can arise at any time, so you'll need to take that into consideration. That's why they call it insurance.

If you're shopping for a new policy on the insurance exchanges or are eligible for Medicaid, the answer is "Maybe." For private policies purchased through the exchange, it all depends on the list of doctors that the health plan considers 'in network.' If your doctor isn't in the plan's network, you'll likely pay a higher amount for co-insurance or copayment. The number of doctors who take Medicaid is growing in states where the program is being expanded, but the number of doctors who take Medicaid is still limited in most areas.

No. Insurers are not required to sell through the exchanges. In several states, for example, the largest insurers decided not to offer insurance this year, while they wait to see what happens. Some were concerned about the negative publicity that might result if the exchanges got off to a shaky start. Others wanted to wait to see if this market would be profitable.

There are certain circumstances when you will be able to change plans or add or drop someone from coverage outside the regular annual enrollment period. This could happen if you lose your job; get married or divorced; give birth to or adopt a child; or move to a different state. Any of those life events triggers a special 60-day enrollment period where you can change or buy health insurance on an exchange. Otherwise, you'll have to wait until the next open enrollment. 59ce067264

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