- Marketplaces are Federal or state-run marketplaces where consumers can compare and buy health insurance plans.
- The individual Marketplaces will open on October 1, 2013, with coverage available beginning January 1, 2014.
- All plans available through the Marketplaces will provide comprehensive benefits – from visits to the doctor or hospital, to prescriptions, to screenings for cancer and other conditions.
- In addition to Marketplace for individuals, there will be Marketplace for small businesses.
- To help consumers compare plans from different insurance companies, several standard levels of coverage will be offered. These include Bronze, Silver, and Gold plans. Platinum plans and high cost share/low premium plans will also be available in some states for some people.
- The Marketplaces will also help determine if consumers are eligible for a reduced premium, lower cost-sharing, or for Medicaid or other publicly subsidized health benefits coverage.
- Two types of financial assistance will available through the Marketplace for individuals: one reduces your monthly insurance premium, and the other helps with out-of-pocket expenses for care. Applicants may qualify for one or both depending on household income.
- If you qualify, the Federal government will pay any financial assistance to the insurance company on your behalf.
Q. What if I cannot afford healthcare coverage?
A. The government may provide financial assistance – called subsidies – to help some people pay for health coverage or care if they can’t afford it themselves. This is usually determined by a person’s income level and family size. You will be able to find out if you qualify for financial assistance when the Health Insurance Marketplaces launch in October. But here are some general income guidelines that might be used by the government to see if you qualify and how much help you would receive.
- If you’re single, the range of income qualifying for assistance could be between $15,282 and $45,960. In Hawaii, it could be between $17,596 and $52,920.
- For couples, the range of combined income qualifying for assistance could be between $20,628 and $62,040. In Hawaii, it could be between $23,741 and $71,400.
- For a family of four, the range of combined income qualifying for assistance could be between $31,322 and $94,200. In Hawaii, it could be between $36,030 and $108,360.