What is the Health Insurance Marketplace, and how does it work?
The Health Insurance Market is a service where you can sign up for a health plan with or without a tax credit, compare costs and coverage of the insurance companies that offer insurance in your geographic area, and choose the one that best suits your needs.
The Marketplace has a healthcare.gov website where you can go in person to ask questions and apply for health insurance and even affordable or subsidized insurance, as well as a call center.
Requirements to qualify
To qualify for health insurance, you need to meet some requirements.
- Have a legal status in the United States: work permit, residence, or citizenship, for example.
- Have a social security number.
- Have a minimum income according to the Federal Table.
- If you are married, file a joint tax return.
- Apply during the Open Enrollment Period.
Open registration
The Open Enrollment Period is a 45-day time during the year, generally from November 1 to December 15, where you can apply to purchase health insurance, comparing the options available in the Marketplace.
You can also apply for the government health subsidy during this period if you qualify for it.
Suppose you miss this window to purchase your health insurance on the Marketplace. In that case, you may not be able to access it unless you qualify for a Special Enrollment Period due to a qualifying life event.
Special Enrollment Period
The Special Enrollment Period gives you the ability to access health insurance or modify it if certain situations arise in your life when Open Enrollment has already ended.
Situations such as:
- Marriage or divorce.
- Loss of eligibility for other coverage.
- Loss of dependent status.
- Changes in the family structure (deaths, births, adoption, etc.)
- Permanent transfer to another State.
- Changes in immigration status.
- Increase or decrease in income.
- Government error.
If any qualifying life events occur, you can request a window to modify or purchase health insurance. This period is generally 60 days.
Health insurance premiums, deductibles, coinsurance, copayments, and out-of-pocket maximum
When you decide to purchase health insurance in Florida, there are a few essential concepts you should be clear about to understand how your coverage will work and roughly how much you’ll need to budget for your health care.
Health insurance premiums and deductibles
When we refer to the premium, we are talking about the amount of money you must pay each month to keep your policy in force. Premiums can vary significantly based on plan type and configuration.
The deductible is an amount of money you must cover in the health care you receive before your insurance begins to operate. Some deductibles will be low, and others may be higher, depending on your plan.
Both the premium and the deductible may vary since it is usual that you can pay lower premiums for a high deductible. For lower deductibles, you may have to pay higher premiums.
Coinsurance and copays for health insurance
Although some services may be exempt from these charges, many services will be, and you will have to cover them.
A coinsurance is a sum of money you must pay for specific care received and whose cost is shared with your insurer. These payments are defined by percentages, which may vary according to the plan you choose.
For example, your insurer may cover 80% if you receive care, so you must cover the additional 20%.
On the other hand, copayments are fixed amounts that you must pay for a particular service. They are not expressed as percentages, and you can know exactly how much you will have to pay for specific care.
maximum out of pocket
The out-of-pocket maximum represents an amount of money established by your insurer, limiting the maximum amount of money you will have to pay for your health care services in one year.
When you reach that spending limit, your insurer will pay 100% of your health care costs. However, this limit may vary according to the plan you choose, but it will be a fixed amount that you will not exceed.
essential basic care
According to the Patient Protection and Affordable Care Act (ACA), all health plans must guarantee health care services that allow people to prevent future complications and illnesses and take better care of their health.
For this, the ACA has defined ten essential services that are:
- Prescription drugs.
- Emergency services.
- Preventive and wellness care and chronic disease management.
- Treatments for mental health, behavioral and addictions.
- Lab tests.
- Pediatric care.
- Ambulatory care.
- Hospitalization.
- Maternity, pregnancy, and newborn care.
- Devices and services for people with injuries, disabilities, or chronic conditions.
These ten essential health benefits defined by Obamacare seek to prevent people from stopping attending health services by avoiding high costs, allowing preventive care, and seeking to reduce the high prices that an emergency visit can cause.
Health insurance metal levels
All health plans must cover at least ten essential health benefits, as we explained earlier.
However, there are different health plans, and you must choose from the one that best suits your budget and needs.
Health plans are divided into metal levels to help you choose which class best suits your needs. The difference between these plans is in the level of coverage.
When choosing a metal tier, you’ll need to consider deductibles, premiums, copays, and coinsurance, as these may vary between stories.
bronze plans
It is the level with the lowest monthly premiums but also the one with the highest deductibles. Your insurance company will cover 60% of the care at this level, and you will have to cover 40%.
Bronze level plans are recommended if you qualify for the tax credit and do not require regular visits to health care services.
silver plans
With the silver-level plans, you will have to pay an average monthly premium, and the care costs will be moderate.
Your health insurance company will pay 70% of covered health care costs at this metal level, and you will be responsible for the remaining 30%. Although the deductibles on the silver level are lower than on the bronze level, your deductible is still high.
Some plans at this level may offer some copay care before you meet your deductible amount. This may benefit you if you require regular maintenance due to a chronic condition.
To learn more about the conditions required to obtain the benefits of this plan, do not hesitate to contact us. We will provide you with the information and support you need for this process.
Gold Plans
Although, at first glance, the premiums are usually higher than those of the previous levels, the advantage of choosing a Gold plan is that the costs that you must cover when you require care will be below.
If you are willing and able to pay higher monthly premiums, it will be a great option if you need a lot of care.
The health insurance company in Florida will cover 80% of the health care costs, and you will be responsible for the remaining 20%.
Platinum Plans
It has the highest monthly premiums but the lowest cost if you require care. This may be the best option if you have a severe condition, require regular visits to health professionals, or have planned surgery.
In this type of plan, your health insurance company will cover 90% of your health care costs, and you will have to pay only the remaining 10%.
Is it essential to have health insurance?
Many Americans have been on the verge of bankruptcy due to having to cover the entire medical expenses of an event that affected the health of one of their family members or themselves.
According to studies in Florida, many people see health insurance as an unnecessary expense because their health is good. However, no one is exempt from something happening, and at that time, your health insurance can be of great help.
