Tiptastic Tuesday: What You Should Know About the New Online Marketplaces

The new online marketplaces or exchanges, which allow consumers to go online and comparison shop, will be open October 1st.  Here are some tips on what to do look for:

  1. Online marketplaces: Enrollment begins October 1st for policies which begin January of 2014.  These will make it easier for consumers to find out if they will be eligible for federal subsidies or Medicaid.
  2. All states will have exchanges: 16 states and DC have their own, 27 states will have federally run exchanges, and seven states will be run by a state and federal partnership.
  3. Exchanges available to most Americans: Although these exchanges are primarily for the uninsured, most states will offer a Small Business Health Options program (SHOP exchanges), which will give employees more options.
  4.  Illegal Immigrants not eligible for exchanges: Legal immigrants eligible if their income is no more than 400 percent of the federal poverty level.
  5. You can opt out of employer coverage: If you find a better deal, you can buy a plan on the exchange.  You will only be eligible if you make less than 400 percent of the federal poverty level.
  6. You can shop for coverage on or off the exchange: Subsidies are only available for plans on the exchange. Adults 26 and younger can stay on their parents’ insurance.
  7. You can go online or apply over the phone.
  8. Exchanges NOT the only place to get subsidized coverage: According to a rule proposed by the government in June, consumers will be able to buy an exchange approved plan and receive a subsidy from the insurance company, if eligible.
  9. If you’re on Medicare, you do not use the exchange.
  10. Federal employees will continue to get coverage through the Federal Employees health Benefits Program (FEHBP).
  11. Plans will be divided into four types: bronze, silver, gold and platinum and will vary in terms of deductibles, copayments, etc.
  12. Plans will offer “essential benefits” which include hospital, emergency, maternity, pediatric care, and coverage for prescription drugs and lab services.
  13. There is help for those who can’t afford premiums: subsidies and cost-sharing for those eligible individuals and families.
  14. Subsidies limited for those who meet certain income requirements ONLY.
  15. If you earn less than 138 percent of the federal poverty level, you will qualify for Medicaid: 21 states have opted out of expanding Medicaid, however.
  16. Insurers are not required to sell through the exchanges.


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