Health Insurance Marketplace

The Health Insurance Marketplace (Marketplace) is a federally operated insurance marketplace where individuals and families can purchase and compare health plans. The Marketplace is primarily accessed at www.healthcare.gov or by telephone at 800-318-2596.

An individual health plan may be purchased for you and your family during the annual open enrollment period with the Marketplace.

For information on how to purchase a health plan outside of the Marketplace, please refer to Shopping for a Health Plan.

When purchasing health coverage through the Marketplace, it’s beneficial to understand the following:

• Advance Premium Tax Credits
• Cost-Sharing Reductions
• Marketplace participation

What You Should Know

An APTC is a federal tax credit that is used to lower the monthly cost of a Marketplace health plan. Eligibility for an APTC is available for those with a household income between 100 percent to 400 percent of the federal poverty level. The federal poverty level is adjusted annually. The Marketplace will determine your eligibility for an APTC. If you are eligible and use a Marketplace APTC to lower your monthly premium payment, you will have to “reconcile” the credit when you file your federal taxes. For additional information and a step-by-step guide to reconciling your APTC, visit www.healthcare.gov.

• Deductibles
• Co-payments
• Co-insurance
• Out-of-pocket maximum

To qualify for a CSR, you must purchase a silver level health plan on the Marketplace and have a household income between 100 percent to 250 percent of the federal poverty level. The federal poverty level is adjusted annually.

Not all health insurers choose to participate in the federal Marketplace. Prior to selling plans on the Marketplace, an insurer's qualified health plan and rates must be certified by DIFS and the federal government.

• Platinum Level - These plans must cover 90 percent of expected health care costs and you are financially responsible for the remaining 10 percent.
• Gold Level - These plans must cover 80 percent of expected health care costs and you are financially responsible for the remaining 20 percent.
• Silver Level - These plans must cover 70 percent of expected health care costs and you are financially responsible for the remaining 30 percent.
• Bronze Level - These plans must cover 60 percent of expected health care costs and you are financially responsible for the remaining 40 percent.
• Expanded Bronze Level - These plans must cover between 56% and 62% of expected health care costs.
  • If an expanded bronze plan covers and pays for at least one major service, other than preventive services, before the deductible, or meets the requirements to be a high deductible health plan, it must cover between 56% and 65% of expected health care costs.
  Catastrophic Health Plans
  • Have lower premiums and higher deductibles.
  • Cover three annual primary care visits prior to the deductible being met.
  • Cover preventive services at no cost.
  • Are not eligible for federal tax credits.