What Is The Marketplace?
Also known as the Federally Facilitated Marketplace (FFM) with the online presence at healthcare.gov, the Marketplace is a shopping experience for health insurance qualified under the Affordable Care Act. It is for eligible persons under 65 years of age.
Not every state operates in the FFM as some have opted to open their own state based exchanges.
For clarity we only operate and receive Marketplace referrals through healthcare.gov (Help On Demand) in select states and do not operate in states with state based exchanges. We also insist on being aligned with all insurers available in the state to present equal footing in the shopping experience. We consistently earn awards as top Marketplace producers nationwide and have been in the game since Day 1.
How Does Marketplace Coverage Work?
There are a lot of moving parts mostly relevant to those who qualify for some financial assistance that comes in the form of Advance Tax Credits. For example household members count even if they are covered by other insurance such as Medicare or the Children’s Health Insurance Plan (CHIPs). Larger households can qualify with more income.
Also since household income is a key component in determining the level of financial help, it is vital to understand that income for this calculation is counted differently than for income taxes. We have seen countless examples of income understated and that could prevent any help from being awarded or financial payments (the same Advance Tax Credits) to be billed back upon filing tax returns.
On the other hand in the case of self employed persons, income is confused with revenue or miscounted when exempt resulting in no tax credits where such help should have been made available.
All Plans Include
- Preexisting conditions are covered from Day 1
- Financial assistance based on income
- Some plans may have zero deductibles and copay.
- Some include dental & vision.
- Can only be dropped for nonpayment of premiums
We Are Direct To The Marketplace (and that makes your life easy).
The Center for Medicare and Medicare & Medicaid Services (CMS) runs the Marketplace and Medicare as well. We are required to annually renew certification through coursework and testing and have an Enterprise account with CMS that grants us direct access under our own user name and password. Security is a critical concern and we never have to ask for Marketplace login information from a client.
We can easily correct application errors, upload stipulations like verification of income or residency and many times it results in a better rate as our understanding of what counts and what doesn’t is advanced over the experience of thousands of files.
Why We Are Simply A Better Marketplace Experience!
First and foremost we work for our clients and our services are free, period. Through the application in the insurers we represent, the hand off to the Marketplace is direct that means no long waits for a (most likely unlicensed) call center rep.
Any required documents like pay stubs, residency proof and qualification for special elections can be transmitted to us securely where we can upload it direct to the client Marketplace account, through our Enterprise login. There are many, many stories of policyholders who lost their coverage, some in a stage of serious need due to lost, unacceptable or missing documents.
Your rate is not affected by using our licensed, certified agents. All insurance is regulated and plan rates are submitted and approved well in advance of Open Enrollment. In fact we have found many cases where rates have decreased and benefits increased due to our experience.
Doctor database searches, medication cost comparisons, and income calculations for tax credits are all included and routine. No short cuts. That said if your prior year application has not changed we can access it directly and streamline the renewal or new plan shopping experience.
Beware The “Zero Premium” Plan
Plan premiums in the Marketplace can be reduced to zero if there are sufficient tax credits. For the same person or family, a small premium may yield far greater benefits and less risk. It is important to look not only at the monthly payment but also what you are getting for your healthcare dollar.
How Can I Apply For a Marketplace Health Plan?
Until November 1 2020 when Open Enrollment for plan year 2021 begins, Marketplace applications are subject to conditions that qualify you for a “Special Election Period” (SEP). Most commonly, a loss of coverage either with an employer, with a primary spouse aging into Medicare or loss of Medicaid or CHIPs have been triggering the SEP. Marriage, divorce, childbirth, release from incarceration, moving out of a plan service area, gaining residency are some of the other more common qualifying events.
If you must wait until Open Enrollment (OEP), you can connect with us prior as new plans will emerge well ahead of 11/01.