The state Health Insurance Marketplaces (originally called Health Insurance Exchanges) were created under the Affordable Care Act (ACA). They are state-based competitive marketplaces where people and small businesses with fewer than 50 employees can shop for and purchase private health insurance. The Marketplaces provide: 

• More choice, giving consumers a choice of health plans to fit their needs.
• More competition, making it easier for consumers to compare plans on the basis of price, quality and benefits. This gives insurance companies incentives to offer better products at lower prices than their competitors.
• More clout, giving 25 million individuals and small businesses the same purchasing power as big businesses by bringing people and businesses together, lowering costs by spreading the cost of insurance across a larger group of people, and allowing insurance companies to reduce prices.

The state Marketplaces are not private insurance companies or government-run health plans. Rather, they are a state-specific resource consumers can use to find out if they qualify for private health insurance plans and other health insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP). In the Marketplace, many consumers will receive tax credits, and cost-sharing reductions. And Marketplaces will help consumers choose the best coverage for their individual needs and budgets. With one application, they can learn about all their options and enroll on the spot.

Key Consumer Resources

How It Works

Starting October 1, 2013, consumers will be able to file a Marketplace application. But everyone is encouraged to create his or her Marketplace account now, to be ready to enroll on October 1.  Remember, consumer health insurance coverage begins as early as January 1, 2014.

Getting health care coverage is relatively quick, 4-step process:

1.       Create an Account

2.       Apply

3.       Pick a Plan

4.       Enroll

Each State Marketplace will tell consumers automatically if they qualify for discounts or qualify to participate in other state programs, like Medicaid, based on their income.  Once a consumer is approved, he or she can choose the best health plan through the online plan comparison tool, or based on information provided on-site by navigators, or through mailed information following a phone call to the Marketplace.

Once a consumer enrolls in a plan, he or she will receive an insurance card. If enrolled by the 15^th of a month, insurance will become effective the first day of the subsequent month. When the consumer enrolls in a plan, any tax credit for which the person is eligible will be sent directly to the health plan, thus reducing the cost of the insurance.  If a consumer is eligible for Medicaid/CHIP, the information will be sent to the Medicaid/CHIP state agency for action and coverage under that program.  While coverage under the Marketplace options begins January 1, 2014, coverage under Medicaid/CHIP begins immediately for eligible individuals, including those eligible through Medicaid expansion in states that offer this option.         

How One Can Connect

Consumers and family members can get information online, by phone through a toll-free call center, by mail, or in person.  Accommodations will be available for persons with disabilities, such as telephone TTY and 508-compliant computer-based resources.  Materials are adapted for non-English speakers in over 150 different languages; many Marketplace personnel, including navigators and other trained assisters, are multilingual (including ASL).

Consumers can:

• Find out if they are eligible to buy health insurance through the Marketplace at: https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace/
• If they are eligible,  they can learn more about how a Marketplace works, key deadlines, and what they need to do how to use a marketplace by going online to: https://www.healthcare.gov/using-the-marketplace/

For an overview of online information for consumers and families, the ACA portal is a particularly good resource at:  https://www.HealthCare.gov  (English) or https://www.cuidadodesalud.gov (Spanish).  Remember, most local libraries have computers available for library patrons, in case a computer isn’t available at home for a consumer to use.

Alternatively, information is available 24 hours a day, seven days a week by toll-free telephone at:

• 1-800-318-2596 ; or
• 1-855-889-4325  (TTY)

One Can Get Ready Now

Even though there is still almost a month before enrollment opens, there are a number of things that consumers can do to get prepared (and you can encourage them to do so!)  For example, they can:

• Sign up for e-mail or text messages about the Marketplace by going to the website https://www.healthcare.gov/subscribe/.  They also can visit Facebook or Twitter, respectively, at https://facebook.com/healthcare.gov  or follow @healthcare.gov on Twitter.
• Learn about the different types of health insurance coverage by using the Marketplace.  They can be better prepared to choose a plan if they understand the kinds of coverage from which they can choose.
• Make a list of questions about their coverage needs before it’s time to choose a plan, including questions about how the coverage works regarding such topics as deductibles, out-of-pocket costs, co-payments, and coinsurance.
• Set a budget for health care insurance based on their needs and income.
• Know about other health care options, such as coverage through an employer, Medicaid, CHIP and Medicare.
• Perhaps most important, find out which Marketplace will serve them.  States that have chosen to run their own Marketplaces will have their own state websites. The federal government will manage the Marketplace for any state that has opted not to run its own. (Consumers can use the https://www.HealthCare.gov website as a first stop for information about their state Marketplace.)

Next Steps

Almost 11 million uninsured persons have behavioral health conditions. Thus, we have a huge task ahead to promote health insurance enrollment as broadly as possible. Hopefully, this information will facilitate that endeavor.