Healthcare reform: What you need to know about the health insurance marketplace or exchanges

Healthcare reform: What you need to know about the health insurance marketplace or exchanges

Q: Are the terms marketplace and exchange the same?

A: Yes. When referring to purchasing federally required health insurance, both terms mean the same thing.

Q: So, what is the health insurance marketplace or exchange?

A: It’s an online marketplace where individuals and small employers can comparison shop for health insurance. Through the exchange, individuals and families can apply for means-tested federal subsidies to help reduce the cost of insurance. While most people can shop for health insurance through an exchange in their area, only those with incomes below 400% of the federal poverty level may qualify for federal subsidies. Lower-income individual and families will also be able to find out through an exchange if they are eligible for benefits through Medicaid and CHIP.

Q: If I’m covered by a DMBA medical plan, can I shop for other insurance on the marketplace?

A: Yes. But you should be aware of the following issues:

  • If you’re eligible for medical benefits through your employer-sponsored plan and you choose to purchase insurance through the marketplace instead, you will not qualify for federal subsidies to help buy insurance from the exchange. These tax subsidies are available to certain individuals who are not eligible for an employer-sponsored plan and only in cases where total household income is less than 400% of the federal poverty level. Remember, you may already receive a significant subsidy (premium contribution) from your employer and this money is also tax exempt.
  • Your employer cannot help pay for your premiums or other healthcare costs (e.g., deductibles, coinsurance, etc.) if you purchase insurance through the marketplace. If you’re eligible for medical benefits through a DMBA participating employer and you choose to purchase insurance through the marketplace, you will lose the employer contribution to premium and related healthcare costs.

Q: How do I know if I’m eligible for medical benefits through my employer?

A: Generally, if you’re regularly scheduled to work an average of 30 or more hours per week for a DMBA participating employer, you may qualify for employer-sponsored benefits. If you have questions about your eligibility, you should contact your employer’s Human Resource Department. If you’re not eligible for your employer’s health plan, you can purchase insurance through the marketplace.

Q: Where can I learn more about the marketplace?

A: You can phone a call center at 800-318-2596 or go to www.Healthcare.gov

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