What is the Health Insurance Marketplace and How Can I Use It?

The Health Insurance Marketplace is still a relatively new program in the U.S., as the first official plan year started in 2014. The Marketplace is intended to provide Americans with increased access and affordability to quality health insurance plans. If you’re thinking about whether to purchase health insurance or shop for a new plan on the Marketplace, then you may— like many people— still have questions. Maybe you’re not sure what exactly the Marketplace is. Maybe you’re wondering if you’re eligible, or if you can save money on health insurance using one of the available plans. 

This Money Chat will provide a basic overview of what the Marketplace is, who can use it, and how to apply. 

Who Can Use the Marketplace?

The Marketplace provides options for eligible individuals and families to apply for health insurance without having to rely on an employer-offered plan. It provides affordable options for Americans who are self-employed, part-time employed, unemployed or employed without employer-offered coverage. It also provides alternatives for Americans who have access to employer-offered plans and options for small businesses looking for ways to provide health plans to their employees. To be eligible to apply, you must live in the United States, be a U.S. citizen or national (or lawfully present), and not be incarcerated. 

What Providers are Involved? 

The participating providers vary and include various private health insurance providers (many of the same companies that employer-provided plans use). Applying through the Marketplace allows consumers to compare the available plan options before making a selection. The Marketplace is also set up to coordinate with the resources provided by the state-specific programs provided through Medicaid and CHIP (Children’s Health Insurance Program) legislation. Individuals applying for health insurance for themselves— and if applicable, their partner, family, or dependents— can submit one application to be considered for all of these options at once. 

When Should I Apply?

Open enrollment, or the period when you can submit your application, is from November 1 through December 15 for plans that start January 1. However, you may still enroll until January 15 for a plan that starts February 1. There are also special enrollment periods for qualifying individuals. If you lost coverage, got married or divorced, or had another qualifying life event, you may be eligible to enroll outside of the standard enrollment period. (Keep in mind that you can separately apply for Medicaid or CHIP at any time by contacting your state Medicaid office.)

How Do I Apply to the Health Insurance Marketplace?

There are several ways to apply, but the most direct way to ensure you are considered for all government-related programs (health plan tax rebates, Medicaid, CHIP) and also have the ability to compare multiple private plan options is to apply directly through the Marketplace online at healthcare.gov. Consumers can also call the Marketplace Call Center for assistance with applying for and selecting a plan. Some states have a separate state Marketplace website; if your state does have a separate website, you will be automatically redirected to it once you select your state during the application process on healthcare.gov. 

Can Someone Help Me Apply?

There are more details about how to apply and who may be able to assist you in your area on the Healthcare.gov website page, “How to Apply and Enroll.” As noted on the website, you can also work with an agent or broker for assistance shopping for a plan. Keep in mind that working with an agent who represents one of the private healthcare insurance providers will limit the options you learn about to plans provided by that provider, and you may not learn about available tax rebate options either. A broker is someone who works outside of the providers and helps consumers compare plans from different providers. Some brokers charge a fee for this service; some do not. There may even be a nonprofit in your area available to assist at no cost. Consumers can also apply by themselves (or with assistance from a friend or family member if they prefer) directly on the website.

How Long Does it Take to Apply?

Be prepared to spend a little bit of focused time getting through the application process. Information you will need include social security numbers for all who need coverage and basic employment and income information. The more people on the plan, the more time you should set aside to complete the application. Overall, the online process is generally quick and efficient. Completing the application should not take more than an hour or two at the most. 

When Will I Know My Options?

Once your application is submitted, you will receive an Eligibility Notice. If you applied online, this may be provided the same day in the “Messages” section of the account you created. If you are eligible for a Marketplace plan, you can review your options immediately and choose a plan. If you or your dependents are being considered for Medicaid or CHIP eligibility, it may take several days at a minimum to receive notice whether you and/or your dependent(s) qualify for those programs. This can vary by state, and you may have to wait for a response by mail or follow up with your state Medicaid office. 

Will the Health Marketplace Save Me Money?

Whether or not you will save money by choosing a Marketplace plan depends on a few factors, and the answer is not the same for everyone. Factors can include your state, your income, number of people on the plan, and more. Some people find much more affordable options through the Marketplace; some people find their Marketplace options comparable to what their employers offer; and some people find it’s their only way to access any kind of health coverage at a reasonable rate. For a deeper look at whether or not the Marketplace is right for you, visit the Investopedia article, “How to Cut Your Costs for Marketplace Health Insurance.” 

American Rescue Plan

While the premiums you are offered on private Marketplace plans may or may not turn out to be as low as you hope for, tax credits provided by the 2021 American Rescue Plan might be a factor to consider in the overall cost of the plan. Those enrolled may see savings in their 2021 or 2022 tax returns due to the Rescue Plan. If you have received your Eligibility Notice but are still unsure whether you qualify for any tax incentives on a Marketplace plan, call the Marketplace Call Center with your questions. 

Additional Resources

For information about the Health Insurance Marketplace, please visit healthcare.gov. For information about Medicaid programs, please visit medicaid.gov. 

If you want to learn more about financial literacy or your rights as a consumer, please visit the Receivables Info Money Chat page.

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The information contained in this article is meant to serve as general guidance for consumers and not meant to serve as comprehensive financial advice. For questions about your individual circumstance, finances, or accounts, please contact your creditor(s) and/or financial advisor directly.

Thank You To Our Sponsor

This article was sponsored by Capital Management Services, LP, a nationally licensed collection agency headquartered in Buffalo, NY that provides the highest quality of proven recovery and project solutions across the financial industry. CMS maintains a reputation as a proven leader and performer through attention to detail and tailoring strategies to meet the unique needs of each portfolio or project. The CMS team is proud of their ability to consistently surpass all industry standards for quality and provide outstanding services that add strategic value to every client partnership.