The 5 W’s of Marketplace Health Insurance
Knowledge based on the 5W’s of marketplace
health insurance should serve as a reliable foundation for understanding and choosing coverage which meets the
qualifications of the Obama health plan. The 5W’s stand for what, why, who, when and where.
is marketplace health insurance?
Marketplace health insurance is coverage obtained
through one of the governmental health insurance exchanges which provides a minimum standard of benefits known as
the essential health benefits as specified by the Patient Protection and Affordable Care Act, referred to by many
as ObamaCare. The plans are sold by private insurance companies and generally are HMO and PPO plans. Each plan
has a metal designation of bronze, silver, gold, or platinum, depending upon services covered and the actuarial
value of the plan. Marketplace health insurance plans cannot deny coverage or charge a higher premium for
pre-existing illnesses. They cover some preventive care services.
purchase marketplace insurance?
The answer to this question rests in Affordable-Care-Act
subsidies, also known as premium tax credits, and whether or not you qualify. Eligibility for Affordable-Care-Act
subsidies is based on annual household income provided that income is at least 133% but less than 400% of the
federal poverty level beginning in 2014. The premium tax credit calculation is based on a provision of the
Affordable Care Act that no American should spend more than 9.5% of household income on medical insurance
premiums. Given that provision, Obama-health-plan insurance could be purchased outside of the marketplace from a
broker or insurance company. The dollar amount of the annual premium in excess of that allowed under the Affordable
Care Act for a given income level could then be claimed as an end-of-the-year deduction during income tax filing.
If the coverage is obtained through a health insurance marketplace however, the credit can be applied to the
monthly premium of any Obama-healthcare-plan selected, resulting in a lowering of the monthly premium of the
is eligible to purchase marketplace insurance?
Marketplace health insurance through the federal or one of
the state insurance exchanges is for individuals and families less than 65 years of age or small businesses with 50
or fewer employees. Eligibility includes United States citizenship and/or legal residence. Additionally, one must
not be incarcerated.
does having medical insurance become mandatory, when can I enroll, and when does the penalty for not having
insurance take effect?
January 1, 2014 is the date that most United States citizens and legal residents must have medical insurance
coverage or suffer a tax penalty of $95 per adult, $47 per child, or 1% of the annual household income (whichever
is greater) if one is uninsured as of January 1, 2014 and coverage has not been obtained by February 15, 2014. Open
enrollment will extend until the end of March 2014. If you have a qualifying life-changing event however, such as
marriage, relocation to another state, loss of job-based insurance or expiration of COBRA coverage, marketplace
insurance can be obtained as an exception at times after the closure of the open-enrollment season in March 2014
and in subsequent years.
Where can I purchase marketplace insurance?
By: Victor E. Battles, M.D. | Published: December 1,. 2013
If you reside in a statewhose health exchanges operated by the federal governmentyou will need to purchasethrough
that exchange. Alternatively, marketplace health insurance can be purchased through a private health insurance exchange if it
has contractual authority granted by the federal government to enroll Obama health plan applicants. As of December
1, 2013, residents of the District of Columbia and states with state operated insurance exchanges must obtain
marketplace medical insurance through the state exchanges. Those states are: California, Colorado,
Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon,
Rhode Island, Vermont, and Washington.
Victor E. Battles, M.D. is a board-certified internist with 30 + years of patient contact. He has been a
principal investigator in several clinical research trials and is the founder of Proactive Health Outlet.
Additionally, he has worked in the areas of quality assurance and utilization review.
Click the following link to compare or choose Obama health plan insurance through a private health insurance exchange.