New Health Insurance Marketplace Frequently Asked Questions
What Are the Minimum Services Required by the ACA?
One way the ACA reforms health insurance is by mandating that all insurance policies offer a basic level of "essential health benefits" such as:
- Ambulance services
- Emergency room and hospital stays
- Newborn and maternity health care
- Substance-use disorder services
- Mental health services (plus behavioral health treatments)
- Preventative and rehabilitative healthcare services
- Wellness programs
- Laboratory services
- Pediatric health care (plus dental and vision coverage).
Is the New Health Insurance Marketplace Only for Private Health Plans?
Ideally, the federal government's marketplace allows you to price-compare health plans from private insurers and also awards tax credits and subsidies afterward. But you can use the marketplace to see if you qualify for Medicaid in your state, or any other government-sponsored health insurance program such as Medicare, CHIP for children, or TRICARE for military families.
How Does the New Health Insurance Marketplace Help People Afford Health Coverage?
The ACA helps individuals and small businesses buy health insurance in two ways. For those who qualify based on income and household size, the ACA gives tax credits to help pay monthly premiums. Also, for those who qualify, the ACA gives subsidies to help pay out-of-pocket costs for those who still cannot afford to buy health plans through a health insurance marketplace.
Does Everyone Have to Buy Insurance Through the Marketplace?
No. The ACA does not force individuals, families, and businesses to purchase health plans through health insurance marketplaces. The marketplace supposedly helps individuals and small businesses purchase "low-cost" health plans. In reality, these plans may not meet you and your family's health care needs, which is why a custom health plan may be the best choice.
Do New Health Insurance Marketplaces Reform Health Care?
In essence, the ACA is all about health insurance reform - not health care reform per se - though changing the way people buy health insurance will have marked impacts on health care delivery in the US. By attempting to expand access to health insurance, the ACA's overall goal is to improve health care in the US, but the ACA does not force changes to the way you and your doctor manage your health. This distinction is important to keep in mind.
What Is the New Health Insurance Marketplace?
The purpose of the new health insurance marketplace is to expand access to affordable health insurance for the uninsured. However, your state may refer to this marketplace as a "health insurance exchange," which may explain the confusion.