Frequently Asked Questions

You've Got Questions. We've Got Answers.
My job offers health insurance. Could I still apply to the Marketplace?

 

Yes. You have the option to register with the Marketplace to compare coverage and prices. Keep in mind, if the insurance offered by your employer meets the following requirements, you will not qualify for financial assistance from the Marketplace:

Affordable

  • A job-based health plan is considered “affordable” if the employee’s share of premiums for the lowest cost self-only coverage that meets the minimum value standard is less than 9.5% of their family’s income.
  • In other words, if your share of your premiums for a plan that covers only you (the employee)–not your family–is less than 9.5% of your family’s income, the plan is considered affordable.
  • You may pay more than 9.5% of your income on premiums for spouse or family coverage from your employer. But affordability is determined only by the amount you’d pay for self-only coverage from your employer.

Minimum value standards

  • A health plan meets the minimum value standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population.
  • In other words, in most cases the plan will cover 60% of the covered medical costs and the person with coverage pays 40%.
  • You should ask your employer for help figuring out if the plan offered to you meets the minimum value standard. Your employer can also give you the information needed to determine if the plan is considered affordable to you.
Once I’ve filled out the application on the Marketplace, am I insured?

 

To complete enrollment and guarantee coverage, you must enroll in the plan in the Marketplace and submit your first month’s premium payment TO THE INSURANCE COMPANY – NOT THE MARKETPLACE- BEFORE the deadline. Not finishing enrollment and/or not paying your first month’s premium on time may result in loss of financial assistance, loss of coverage, and may require you to pay the penalty for not having health insurance.

 

When will my insurance coverage start?

When your coverage begins depends on the following:

  1. When you enrolled in your insurance plan, and
  2. When you paid your first month’s premium to your insurance plan

Typically, your insurance start date is determined by your insurer. Be sure to ask about how and when to may your premium payment and the due date.

Can I still see my current doctor with my new insurance?

 

Seeing your current doctor under your new policy depends on if your doctor accepts your new insurance and if your doctor is “in network” for your new policy. We recommend that you contact the insurer of the policy you are interested in purchasing to verify that your doctor participates. Doing this BEFORE you enroll can guarantee whether or not you get to keep your doctor, how much your costs will change, and what services will and will not be covered.

I have never had insurance before/don’t understand insurance terms. Where can I get help?

Click here for an explanation of Common Insurance Terms and Issues.

If I got health insurance from the Marketplace last year, will I have to reapply?

Yes. You may have selected the option to have the IRS review your income information from your Federal Income Tax and update your application accordingly. However, income information is sensitive and depending on how high your income is, your coverage and/or tax credits may not be automatically renewed. It is recommended that you contact the Marketplace to update your information, confirm your new coverage (if your policy has changed), and verify your tax credit.

What determines my health insurance premium costs?

Your health insurance premium costs depend on several factors:

  • Plan category chosen
  • Your household income/whether or not you qualify for financial assistance
  • Your household size
  • Where your live
  • Your age

Health status, pre-existing conditions and gender do not affect pricing.

Do I need any materials to apply to the Marketplace?

To ensure a complete and accurate application, we recommend you have the following available to you:

  • Most recent W-2s, tax filing transcript, or paystubs with year-to-date earnings before tax. The application will require you to enter your anticipated yearly income for 2015, before tax, for yourself and anyone else who files taxes with you (i.e. spouse and/or dependents)
  • Social security numbers for anyone who is applying for coverage. If you are not purchasing insurance, you are not required to provide your SSN. Those who do not have a SSN may still apply but may not receive financial assistance depending on if they are legally present in the US
  • Bank routing numbers and/or credit card info for paying your premium online. NOTE: you will not pay your premium directly to the Marketplace, after enrollment you will be prompted to the website of your insurer. The Marketplace will NEVER ask for your payment information
I’ve enrolled in a plan, but haven’t received a card or letter. What should I do?

Once you enroll in a plan, your insurer should contact you about making your first payment and receiving an insurance card. HOWEVER, it is important that you contact your insurer at least 72 hours after you have enrolled to guarantee your information has been received so you can make your first payment ON TIME. While your insurance company should contact you, not receiving correspondence is not an excuse for delayed and/or missed payments. Failure to pay your first premium on time may result in cancellation of your policy, loss of coverage, and could lead to penalties for not being insured.

I have recently lost my job and my income has changed. What do I do?

As soon as your household income changes, you should contact the Marketplace immediately. A change in income means you may qualify for a Special Enrollment Period, which would allow you to adjust your financial assistance and/or change your policy to better fit your budget. You only have 60 days after a qualifying life event to change your information, so act quickly!

What are examples of a “qualifying life event”?

A Qualifying Life Event is a change in your life that can make your eligible for a Special Enrollment Period to enroll in health coverage. Examples would include:

  • Marriage or divorce
  • Having a baby, adopting a child, or placing a child for adoption or foster care
  • Moving your residence, gaining citizenship, leaving incarceration
  • Losing other health coverage—due to losing job-based coverage, the end of an individual policy plan year in 2015, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a Special Enrollment Period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.
  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
I was unemployed during Open Enrollment and never applied to the Marketplace. Open enrollment is over and I now have income. Does this qualify me for a Special Enrollment Period?

No. Since you didn’t apply during Open Enrollment, the Marketplace cannot confirm when you began to receive income. Applying when you are unemployed but still looking for work will exempt you from the penalty while you are not working and allow you to change your income during a Special Enrollment Period when you start working. If you do not register during Open Enrollment and become employed afterwards, you may be required to pay the penalty for not having insurance for the entire year, even if you weren’t employed at that time.