1- Health Insurance Marketplace
The Health Insurance Marketplace is an online platform where individuals and families can compare and purchase health insurance plans. There are state-based Marketplaces, federally facilitated Marketplaces, and state-federal partnership Marketplaces.
2- Open Enrollment Period
Open Enrollment is the period during which individuals can enroll in or make changes to their health insurance plans for the upcoming year. The dates for Open Enrollment may vary each year but typically occur in the fall.
3- Subsidies and Cost-Sharing Reductions
The ACA provides subsidies and cost-sharing reductions to help eligible individuals and families afford health insurance. Premium subsidies are based on income and are designed to lower the cost of monthly insurance premiums.
4- Essential Health Benefits
Health insurance plans offered through the Marketplace must cover essential health benefits, including preventive services, prescription drugs, maternity care, mental health services, and more.
5- Pre-Existing Conditions
The ACA prohibits insurance companies from denying coverage or charging higher premiums based on pre-existing conditions. This provision ensures that individuals cannot be denied coverage due to their health history.
6- Medicaid Expansion
The ACA encouraged states to expand Medicaid eligibility to provide coverage to more low-income individuals and families. However, not all states have chosen to expand Medicaid.
7- Individual Mandate (No Longer in Effect):
The ACA initially included an individual mandate, which required most Americans to have health insurance or pay a penalty. However, the penalty for not having insurance was effectively eliminated starting in 2019.
8- Special Enrollment Periods
Outside of the Open Enrollment Period, individuals may qualify for a Special Enrollment Period if they experience certain life events, such as marriage, the birth of a child, or loss of other health coverage.
9- Healthcare.gov
Healthcare.gov is the federal Health Insurance Marketplace serving residents of states that do not have their own Marketplace. Residents of states with their own Marketplaces can use their state's platform.