When Do I Qualify for the Health Insurance Marketplace

During the health insurance open enrollment period (the time where you can enroll in or change your health insurance coverage), it’s important to understand the Health Insurance Marketplace. The Health Insurance Marketplace tends to be a big source of confusion. How do you know if you qualify to shop on the Marketplace? And is it for only those without insurance? Here we break down the basics for when you should consider the Marketplace for your health insurance.

Who should shop for health insurance on the Marketplace?

The Marketplace is for those that do not have health insurance through another avenue such as their workplace, Medicare, or Medicaid. If you have an option through another avenue, you can buy a plan through the Marketplace, but you’ll most likely pay full price. Keep in mind you will need some type of health insurance to avoid a penalty fee.

How do I know if my plan counts?

There are many types of plans that count and allow you to avoid a penalty fee. The most common are job-based plans, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and most student health programs. It is important to note that only Medicare Part A or Part C qualifies for acceptable coverage. Medicare Part B, alone, does not. See all policies that qualify here.

Even though job-based plans typically qualify, the Affordable Care Act also requires that health insurance plans be affordable and meet certain standards.

How do they measure affordability?

A plan is deemed affordable if it pays at least 60% of the total cost of medical services and your share of the monthly premium [for your coverage only] is less than 9.56% of your household income. For example, your monthly income is $2,000 and your premium for single coverage is $300, which means your premium is 15% of your household income and not “affordable.” In this case, you would qualify for a Marketplace health plan, and depending on your yearly income, possibly savings on that plan. However, most job-based plans meet these requirements. ( More information about affordability.)

What incomes are eligible?

Whether or not you will qualify for health insurance plan savings depends on both your income and your household size. You can determine if you qualify here. Remember, this is assuming that you do not have a health insurance policy through work or it does not meet the minimum requirements.

Because Iowa is a state-partnership marketplace, certified local agents like our very own Gary Winterhof are able to help you with the Health Insurance Marketplace. Feel free to contact him with any questions or concerns. Or visit our site now to find out if you are eligible for any subsidiaries and shop for plans.

If you don’t have health insurance but don’t feel that the Health Insurance Marketplace is right for you, visit our site here where you can shop for Wellmark Blue Cross Blue Shield plans online now.

Next, learn what you can expect when shopping for health insurance using the Marketplace.

Lincoln Savings Bank

Not a deposit | Not FDIC Insured | Not insured by any federal government agency | Not guaranteed by the bank | May go down in value