What is HealthCare.gov and how does it work?

Heard about HealthCare.gov but not sure what it is, what it does, or how to use it? This government website is there to help you get health insurance coverage. But it does more than just let you apply for an Obamacare health plan. HealthCare.gov is full of information about how to apply for Marketplace insurance and the options available to you. Whether you get coverage through Medicaid services or buy an Obamacare plan, HealthCare.gov is yet another way the Affordable Care Act (ACA) helps you get the care you need. 

What is HealthCare.gov? 

HealthCare.gov is a website run by the United States government. It is sometimes called the "healthcare exchange.”

Enter some basic biographical information through the site and then you can compare your health insurance options. Then, from the same site, you'll be able to enroll in your desired plan. When you apply online, the site will also automatically show you any premium tax credits available to you.

HealthCare.gov was launched following the passage of the Affordable Care Act (ACA). The ACA is the landmark Obama administration health care legislation. Among other things, the ACA made it law for people to be able to shop for high-quality health insurance online.

How does HealthCare.gov work? 

There is an annual Open Enrollment Period. During this time, anyone in the U.S. can enroll in a new health insurance plan. And you have a number of choices for how to do so online.

Depending on where you live, you can go to either HealthCare.gov or your state’s healthcare exchange. (Some states run their own exchange). You can also visit HealthSherpa. HealthSherpa is a private site that is the first-ever partner of the federal government that offers a more streamlined way to compare and shop for health insurance online. Using any of these platforms will also let you see if you qualify for monetary assistance with your premiums.

Outside of the annual Open Enrollment Period, HealthCare.gov operates for informational purposes. It is also a tool to manage existing plans for those already enrolled. You can also use HealthCare.gov to shop for a new health plan during a Special Enrollment Period with a Qualifying Life Event. 

Don’t forget that all year long, you can log-in to HealthCare.gov, HealthSherpa, or your state’s exchange to check the status of your enrollment and pay your monthly premium. Remember that all payments you make go straight to your insurance company. Payments never go to the healthcare exchange on which you enrolled. These sites are also available to you should you need to cancel your health insurance plan. 

What is HealthCare.gov’s phone number?

You can reach the HealthCare.gov call center at 1-800-318-2596 (TTY: 1-855-889-4325).

You can apply for coverage by phone via the call center. The call center also lets you continue or finish your application as you began it online or by mail. 

If you start a HealthCare.gov insurance application by phone, once you receive your Application ID you may continue your application online. 

If you wish to complete you application over the phone, someone in the Call Center can also describe all the plans available to you and finish your enrollment right then and there.

What is the Health Insurance Marketplace?

The Health Insurance Marketplace (sometimes just called the “Marketplace” or “exchange”) is a service available so people can shop and enroll in affordable health insurance. The federal government runs the HealthCare.gov Marketplace, which serves the majority of states. A small number of states run their own state-run Marketplace. 

You can shop the Marketplace a number of ways. You can shop online through HealthCare.gov. By phone, you can call the HealthCare.gov call center. You may also start a paper application and can do so with in-person support.

There's also HealthSherpa, the first-of-its-kind partner to the federal government. HealthSherpa allows people to compare, shop, and enroll online in an easy, streamlined manner. HealthSherpa's Consumer Advocate Team is available year-round to help field questions about your health insurance. 

No matter how you shop the Marketplace, you will provide some basic information about your income and household. Then, you will find out if you qualify for any premium tax credits and any other health insurance savings. You’ll also find out if you or any of your dependents qualify for Medicaid or the Children’s Health Insurance Program (CHIP). 

What is a State Based Exchange?

Some states run their own Health Care Marketplace, in lieu of the one run by the federal government. If you live in California, Colorado, Connecticut, the District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, or Washington, you’ll apply for health insurance directly through your state’s exchange. The process will be almost identical to that with which you would apply on HealthCare.gov. 

What is HealthSherpa?

Simply put, HealthSherpa is an easier way to enroll in health insurance.

HealthSherpa is a private partner to the federal government to assist people in enrolling in ACA-compliant health insurance. This means they show all the same Marketplace plans, policies, prices and available cost savings. By enrolling online through HealthSherpa.com, you can comparison shop and enroll in health insurance in a more streamlined manner. Shopping for Marketplace insurance through HealthSherpa comes at no extra cost to you. In turn, you’ll have the tools you need on-hand to research and pick the best insurance available for you. And as an added bonus, you’ll have the year-round support of the HealthSherpa Consumer Advocate Team to guide you through the process when you need it, and be there for any questions or help you might need year-round. 

What kind of insurance plans are offered through the Marketplace?

Marketplace health insurance plans have different metal levels: Bronze, Silver, Gold, and Platinum. Generally, Bronze plans have the lowest monthly premiums but also the highest out-of-pocket costs. This trend continues up the line to Platinum plans, which typically have the highest monthly premiums and the lowest out-of-pocket costs.

All four plans are eligible for premium tax credits, which can help you pay for your health insurance if you meet the income-based qualifications. Silver plans are also eligible for cost-sharing reductions, a subsidy that lowers the amount you have to pay for deductibles, copayments, and coinsurance. Cost-sharing reductions are also known as cost-sharing subsidies in Marketplace health insurance plans. No matter what it's called, these are extra savings on your Obamacare plan.

There is also another type of plan available: Catastrophic. These have even lower monthly premiums than Bronze plans, but they also have very high out-of-pocket costs. These plans cover essential health benefits and are only available to people under 30, unless you’ve obtained a hardship exemption. Catastrophic plans are not eligible for the premium tax credit, however, so depending on your income, a Bronze plan may end up being more affordable after applying a tax credit.

Be sure to compare and shop for your health insurance plan, especially if you qualify for one of the subsidies. A HealthSherpa study during 2018 Open Enrollment found that 18% of enrollees are paying nothing for coverage, with 26% paying less than $10 a month.

What type of health services are covered by Marketplace plans?

Thanks to the Affordable Care Act, all health plans offered on HealthCare.gov cover the following essential health benefits:

• Ambulatory patient services (outpatient care without admittance to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
• Birth control coverage
• Breastfeeding coverage

Who can enroll in a Marketplace plan?

The Affordable Care Act ensure that almost all Americans can buy individual and family health insurance from the online Marketplace. 

To qualify to shop on the Marketplace, there are just a few general requirements. You need to live in the U.S., not be incarcerated, and be a U.S. citizen. You can also shop the Marketplace if you hold a permitted immigration status, like being a refugee or green card holder. 

When can I enroll in a Marketplace plan?

If you meet these general criteria, you can shop for Obamacare plans during the annual Open Enrollment Period (OEP). Each year, there is an Open Enrollment Period when almost all Americans can buy health insurance under the Affordable Care Act. The dates of the Open Enrollment Period change every year, and last for six weeks in most states. Almost everyone who enrolls during OEP will have insurance coverage beginning on January 1st of the upcoming calendar year. 

You can also shop on the Marketplace during a Special Enrollment Period (SEP) if you have a qualifying life event like getting married or welcoming a new child into your family. Here are three general categories of qualifying life events that can trigger a Special Enrollment Period: Loss of health coverage, changes in your household, and changes in residence.

There is no such thing as a pre-set Special Enrollment Period in the United States. Rather, a Special Enrollment Period begins when a person has a qualifying event.

How can I complete the application for Marketplace insurance?

HealthCare.gov offers four ways to complete the application for Marketplace insurance: By phone, online, in person, or by mail. Depending on what method you select and if you have all your information you need on-hand when you apply, the application process might take varying times to complete. 

You can also apply for Marketplace insurance with HealthSherpa. HealthSherpa offers a streamlined, easy-to-understand and easy-to-use system for applying for the very same Marketplace insurance offered by HealthCare.gov through their online system at no additional cost to you. And the HealthSherpa Consumer Advocate team is available year-round to help with any questions and to educate you about your options, as well as the requirements for applying. A quick chat with a HealthSherpa Consumer Advocate can help set you up with all the information you need to be able to apply quickly and easily during the next OEP. And when Open Enrollment starts, the Consumer Advocate Team can help you review and understand your options to make sure you find the health plan that’s best for you. 

Can I get a subsidy for health insurance?

Depending on your income level, you might be able to qualify for some kind of subsidy or savings for your health insurance.

If you live in a state with expanded Medicaid coverage and you earn 138% or less of the federal poverty level, you may qualify for Medicaid. Both Medicaid and CHIP (Children’s Health Insurance Program) are forms of subsidized health insurance. Completing an application for a health plan on HealhCare.gov or with HealthSherpa will automatically notify you if you qualify for either of these programs. 

In all states, however, if your income falls between 100% and 400% of the federal poverty level, you can qualify for a premium tax credit that can lower the amount you pay in monthly premiums. Again, the process of applying for Marketplace insurance will automatically notify you of any tax credits, sometimes called subsidies, for which you might qualify. 

Can I use my health insurance immediately?

If you enroll in Marketplace insurance during Open Enrollment, your coverage will begin on January 1 of the upcoming year. (So, if you apply during Open Enrollment in 2019, your coverage would begin on Jan. 1, 2020.) 

If you enroll for Marketplace insurance during a Special Enrollment Period, coverage begins the following month after you enroll in a health insurance plan. So, if you enroll in a plan on July 15th, your coverage will begin on August 1st. 

Also keep in mind that qualifying life events that prompt a Special Enrollment Period that are related to welcoming a new child, whether through childbirth or adoption, start with that child’s birth or day of adoption. So, complete your insurance application within the 60-day window of the SEP. Then, as soon as your first premium is paid the coverage is effective. In turn, this will also immediately retroactively cover the dates preceding it for your child. That ensures that your new addition is covered from the day you welcome them into your family.

Conclusion

HealthCare.gov and HealthSherpa are here to make sure you can get the health insurance coverage you need. By letting you compare plans and benefits and learn about any subsidies you might qualify for and offering tools and resources to help educate your decision-making, you can be empowered in buying Marketplace insurance and knowing you’re caring for yourself and your family’s health.

Originally published on April 24, 2018