New Health Insurance Marketplace Frequently Asked Questions

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)
• Prescriptions
• Preventative and rehabilitative healthcare services
• Wellness programs
• Laboratory services
• Pediatric health care (plus dental and vision coverage).

Health plans that do not meet these minimum requirements will subject you to the federal government's tax penalty for not having "ACA-compliant" health insurance. Certainly, the ACA has good intentions, but in reality, much confusion and conflicting information still surrounds the law. Knowledgeable insurance advisors understand ACA well. These frequently asked questions will lay the foundation for a constructive conversation. Contact us today to find a health insurance option that is right for you and your loved ones.

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.

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.

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.

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.

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.