The Health Insurance Marketplaces Are Open: What Does It All Mean?

8 things to know about the Health Insurance Marketplaces, which opened today in every state:

  • There are 2 Marketplaces in each state: an Individual and Small Employer (called “SHOP”) Marketplace.
  • 34 states have Federally-Facilitated Marketplaces (called FFM and FF-SHOP); the remaining states and the District of Columbia are running their own Marketplaces
  • The Individual Marketplaces are for individuals wish to purchase health coverage starting January 1st, 2014; the FF-SHOP Marketplaces are open to view plans/rates only, but small employers are not able to purchase a plan online for a 1/1/14 start date until 11/1/13 due to system delays . Further, employers who purchase coverage in the FF-SHOP can only offer 1 plan to all employees vs. offering multiple plans if they purchase coverage outside of the FF-SHOP
  • Individual health insurance options purchased via the Marketplace start 1/1/14 so while individuals may wish to view rates and plans today, they may want to wait until late November or early December before finalizing a plan option for 1/1/14, as employment may change or options for coverage may change by that time. Individuals should only be sure to purchase coverage by 12/14/13 if needed for 1/1/14
  • Plans and rates in the Marketplace MUST be the same as those available outside of the marketplace; further, plans and rates do not change if you list an agent on your policy or if you don’t list an agent
  • If you currently have health insurance through your employer, your spouse’s employer, your parent’s employer, TRICARE, Medicare, or a Veterans’ Health plan, then there’s nothing you need to do. You are covered with ‘minimal essential’ coverage as required by the Affordable Care Act and you will not be assessed a penalty in 2014.
  • If you do not have access to affordable, minimal coverage, then you should go to to shop plan options for 1/1/14, as the requirement to have health insurance by 1/1/14 under the Affordable Care Act  likely applies to you. Further, you may be able to qualify for a premium tax credit if your income meets certain standards (meaning the plan may cost you less than the rate you see online) and you may qualify for a cost-share reduction in benefits (meaning you may have better coverage than what the plan you select shows).
  • Individuals and small employers purchasing through the FFM or FF-SHOP who wish to have an agent listed on their policy, which does not cost anything nor does it change the coverage in any way, can list “Lisa Keith of Princeton HR Solutions LLC”, as “agent” using NPN 7547222  under the ‘Get Help’ section.