Florida Health Insurance Marketplace

Florida Health Insurance Marketplaces (also called Exchanges) are newly organized systems that were created to offer more competitive and organized markets for obtaining health insurance. They aim to provide various health plan choices for consumers to choose the best fit for themselves. Cost-sharing subsidies and premiums will be offered through the Marketplace to give families and individuals reduced coverage based on their average income. Those with very low income will be able to check their CHIP and Medicaid eligibility through the Marketplace. Even small businesses will have the option to purchase coverage for their employees with the help of the SHOP (Small Business Health Options Program) Marketplace.

The health insurance Marketplace will be offered for families, individuals and small businesses in every state. Some of these Marketplaces will even be operated by each state and have an assigned state name (like The Maryland Health Connection or Covered California). In states where the government is in control of the Marketplace, it will be known as The Health Insurance Marketplace of [particular name of state].

Our company helps Florida residents learn what they need to know about the healthcare Marketplace. If you think you will qualify for premium tax credits, then you should visit our On Marketplace Health Insurance quote engine.  If your taxable household income is greater than 400% of the Federal Poverty Level, then you may want to visit out Off Marketplace Health Insurance Quote engine for a no hassle health insurance quote.

We can help you get enrolled in the best plan for your needs. Here are the answers to some frequently asked questions about healthcare and the Marketplace exchanges.

The Marketplace is open all US citizens of the United States who wish to enroll in a healthcare plan. Those who have coverage through Medicare or their employer will not be eligible for premium tax  credits (subsidies).  In addition, you cannot be incarcerated at the time you are attempting to purchase insurance from the Marketplace.

Those who are immigrants to the United States can still qualify for insurance via the Marketplace, if they meet the criteria. These criteria include green card holders, asylees, refugees, those paroled into the US, those considered a battered spouse, child or partner, victims of trafficking, those with a worker visa, members of a recognized Indian Tribe, or residents of American Samoa. There are several other situations that will qualify an immigrant to be granted insurance via the Marketplace, as each situation is unique.

There are several requirements that must be met in order to be eligible for premium tax credits. These include the following:

• You have purchased your insurance through the Marketplace (a Marketplace Plan)
• You have a certain household income, generally if your household income falls between 100 and 400% of the federal poverty line you will be eligible
• You do not have the option to get insurance through your employer
• You cannot have insurance through any government program
• If you are married, you must file Married Filing Jointly in order to receive a tax credit.

Those who meet all of these requirements, will find that they may get premium tax credits.

Premium tax credits are estimated when you apply for health coverage in the Marketplace.(apply for a Marketplace health plan.) The estimation is based on your current family and projected taxable household income for the upcoming year. When your tax credit has been estimated, you can then decide to take (use) the estimated tax credit and apply it to your health coverage plan payment, in order to lower your monthly plan. (Or)On the other hand, you can choose to wait and claim the entire tax credit on your Tax Return the following year. If you do apply the tax credit to your health plan in advance, you will reconcile the credit when filing your taxes.

Generally speaking, you will only have the option of enrolling in The Marketplace during Annual Open Enrollment.

When the Open Enrollment period is over, families and individuals will not be allowed to sign up for Marketplace insurance until the next Open Enrollment period. One of the only exceptions to this rule is that if you experience problems or changes in circumstances over the course of the year, then you will be given a special 60-day opportunity to sign up for Marketplace health care plans.

For families and individuals who are planning on buying non-group plans by themselves, outside the Marketplace, there is only the option to sign up for coverage during the Open Enrollment period and other special enrollment opportunities. Alaska Natives and American Indians will have the option of enrolling in coverage over the course of the year and not just when Open Enrollment is happening.

Within the Marketplace, there are four basic categories that healthcare plans are going to fall into. The difference between the plans is based on the amount that the plan will pay for health costs. The four types of plans are:

• Bronze: On average, you will pay 40% of your health care costs, while the plan covers 60%
• Silver: On average, you will pay 30% of your health care costs, while the plan covers 70% *However, Silver plans are the only plans that cost sharing is applied to. Cost Sharing reduces the deductibles, copays and out of pocket costs. If you qualify for cost sharing a Silver plan may actually be better than a Platinum plan.
• Gold: On average, You will pay 20% of your health care costs, the plan will cover 80%
• Platinum: On average, You will only pay 10% of your health care costs, while the plan covers 90%

Most American citizens will be able to shop for insurance plans in the Marketplace. To be able to shop in the Marketplace, you are required to reside in the state of your Marketplace, be a citizen of the U.S., be legally residing in the U.S. and you must not currently be incarcerated.

It’s important to note that not everyone will be able to purchase subsidized coverage in the Marketplace. In order to be able to qualify for premium tax credits (also known as subsidies), applicants will need to meet other requirements regarding their eligibility and income.

As long as you meet other eligibility requirements, you will always have the option of shopping for coverage in the Marketplace. However, if you currently have access to insurance through your employer, you may not be able to qualify for premium tax credits.

One way to sign up for non-group, private coverage during periods other than Open Enrollment, is if you have a qualifying life event. These are called special enrollment opportunities. These events are the following:

• Losing eligibility for coverage from other providers (like if you were laid off from your job, quit your job or reduced hours at your job, or if you lose coverage from student health plans because you graduated). Keep in mind that loss of eligibility because other insurance premiums were not paid, does not give you the option of having a special enrollment opportunity.
• Adding a dependent to your health plan (like if you were to get married, give birth or to adopt a child). Pregnancy will not give you a special enrollment opportunity.
• Losing a dependent status (like if you were to age out of your parents’ plan)
• Losing coverage because of a legal separation or divorce
• Moving outside the area of your service plan or to another state
• If COBRA coverage is exhausted
• Losing the ability to qualify for CHIP (Children’s Health Insurance Program) or Medicaid
• If, for those currently enrolled in a Marketplace plan, income decreases or increases and changes your eligibility to qualify for certain subsidies
• Changes in status of immigration
• Errors regarding eligibility and enrollment made by a government agency or the Marketplace, like an assister, who is acting on your behalf

Please take into consideration that some qualifying events, while allowing you to qualify for special enrollment opportunities in the Marketplace, may not apply in the outside market. One situation is if you have gained citizenship or earned a lawfully present status, the Marketplace will provide you with a special enrollment opportunity.

Should you experience an event qualifying you for enrollment, your enrollment opportunity will last 60 days from the date the triggering event started?

Some states do have the ability to expand enrollment opportunities for some consumers. To find out more information, check with your state Marketplace.