What Is the Health Insurance Marketplace & How Do I Apply?

FT Contributor  | 

The Health Insurance Marketplace, also referred to as the Health Insurance Exchange, is a health insurance website you can visit to shop for health insurance to meet your needs and budget. To enroll in health insurance coverage through the Marketplace, you must sign up for insurance during the open enrollment period, which is November 1 to December 15 for 2020 coverage.

If you miss the open enrollment period, you may qualify for a special enrollment period — if you’ve experienced a change that makes you eligible. A qualifying change may include getting married, having a baby, getting divorced, moving to a new home, or losing your current health insurance within 60 days.

Should I Use the Insurance Marketplace?

Health insurance is a type of insurance that helps you pay for your medical expenses. The type of policy you purchase and the coverage it includes determines the medical providers and services that are covered, as well as the portion of the medical expenses you’re responsible for when you seek treatment.

You can use the Health Insurance Marketplace to compare policies and coverages if you and your family don’t have health insurance coverage options through an employer. The Marketplace can also be used if you’re self-employed or unemployed and need to obtain health insurance. If your employer offers health insurance, you can still use the Marketplace to get coverage, but you’ll be required to pay full price for your coverage. To shop using the Marketplace you must be a U.S. citizen and current resident who doesn’t qualify for Medicare and isn’t incarcerated.

The Affordable Care Act (ACA) is legislation passed in 2010 that led to the creation of the Health Insurance Marketplace and the premium tax credit associated with coverage sold through the Marketplace. If you qualify for a premium tax credit, the income you earn and your family size determine the amount of credit you qualify to receive. Therefore, if your income or family size changes, you must report this change immediately. These household changes can affect your health insurance premium or your eligibility for a special enrollment period.

What Health Insurance Plans Are Available on the Marketplace?

There are certain levels of health insurance plans available on the Health Insurance Marketplace. These levels vary by coverage and monthly premiums. The policies available to you depend on your location and financial situation.

  • Bronze: Offers the lowest monthly premiums but the highest out-of-pocket costs when you need care. You may pay thousands before your insurance begins to cover medical services.
  • Silver: Offers a moderate monthly premium and moderate coverage. The deductibles for silver plans are lower than bronze plans and more of your routine care is covered.
  • Gold: Offers a high monthly premium but low costs when you need care. With low deductibles, you won’t pay much out of pocket with a gold plan.
  • Platinum: Offers the highest monthly premium but you’ll pay the lowest costs when you get care. If you usually need a lot of medical care, this is the best choice for you since the deductible is low for platinum plans.
  • Catastrophic: Only available to people younger than 30 or those who have a hardship exemption. Offers low monthly premiums but extremely high deductibles, so out-of-pocket costs for care are also high.

Can I Get Federal Assistance?

You may qualify to receive federal financial assistance, which can help you pay your monthly health insurance premiums. To be eligible for the premium tax credit, your household income must fall between 100% and 400% of the federal poverty level, based on the size of your family.

What Is Form 1095-A?

If you use the Health Insurance Marketplace to sign up for coverage, you must file a 1095-A Form with the Internal Revenue Service (IRS). You’ll receive a completed form from the Marketplace at the end of the year. The information provided on this form can be used to complete Form 8962, which is used to claim your premium tax credit with the IRS.

How Do I Apply for Marketplace Plans?

There are four methods you can use to apply for coverage through the Marketplace: online, by phone, in person, or by mail.

  • Online: Visit the Health Insurance Marketplace and navigate to the enrollment page. Provide your zip code and other information to view the available insurance plans. Choose the one that meets your needs and complete the enrollment process.
  • By phone: Call 1-800-318-2596 at any time to enroll in a plan. You’ll need to provide your identification information and choose a plan before enrolling.
  • In person: In some states, you may be able to apply for Health Insurance Marketplace coverage in person by finding a local health insurance agent who specializes in Marketplace insurance. A local agent can help you choose a plan and complete the enrollment process.
  • By mail: Download and print a paper application for Health Insurance Marketplace coverage. Mail your completed application to: Health Insurance Marketplace, Dept. of Health and Human Services, 465 Industrial Blvd., London, KY 40750-0001.

While most states use the federal Health Insurance Marketplace, some states administer their own state-based Marketplaces.

Apply by State

The following states have their own state pages that must be used instead of the federal site to apply for Health Insurance Marketplace coverage.

California

Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725
800-300-1506.

Colorado

Connect for Health Colorado
4600 S Ulster St #300
Denver, CO 80237
855-752-6749.

Connecticut

Access Health CT
PO Box # 670
Manchester, CT 06045-0670
855-805-4325.

District of Columbia

DC Health Link
Exchange Contact Center
PO Box 44018
Washington, DC 20026
855-532-5465.

Idaho

Your Health Idaho
P.O. Box 943
Boise ID, 83701
855-944-3246.

Maryland

Maryland Health Connection
P.O. Box 857
Lanham, MD 20703
855-642-8572.

Massachusetts

Health Connector
133 Portland Street, 1st Floor
Boston, MA 02114-1707
877-623-6765.

Minnesota

MNsure
PO Box 64253
St. Paul, MN 55164-0253
651-539-2099.

Nevada

Nevada Health Link
2310 S Carson St #2
Carson City, NV 89701
800-547-2927.

New York

New York State of Health
P.O. Box 11727
Albany, NY 12211
855-355-5777.

Vermont

Vermont Health Connect
P.O. Box 2060
Omaha, NE 68103-2060
855-899-9600.

Washington

Washington Healthplanfinder
P.O. Box 946
Olympia, WA 98507
855-923-4633.


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