What is the Health Insurance Marketplace?

Often referred to simply as the “Marketplace” or the “Exchange,” this service helps you shop for and enroll in health insurance for you and your family through websites, call centers and in-person help. (The Marketplace is not for people who get insurance through their employer.)

When you apply for individual and family coverage through the Marketplace, you’ll provide income and household information. You’ll find out if you qualify for:

  • Premium tax credits and other savings that make insurance more affordable
  • Coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state

Click here for a quick start guide to the Marketplace. You can also get a quote for Florida Blue coverage here.

What do I need to sign up for Marketplace coverage?

To apply for or re-enroll in your Marketplace coverage, call us at 1-800-352-2583.

You’ll need to provide the following information on your Marketplace application. So it’s a good idea to gather everything before you get started. Note: You won’t need all of it if you’re applying without a subsidy (tax credit).

  • Basic personal information like name and date of birth for everyone applying for coverage
  • Details about each person in your household (even those not applying for coverage)—including your spouse, children living with you and anyone you claim as a dependent on your tax return
  • Home and mailing address (if these are different) for everyone applying for coverage
  • Social security numbers for everyone on your application
  • Information about any professional who might be helping you apply, such as a navigator, agent or broker
  • Immigration document information (applies only to lawfully present immigrants)
  • Federal income tax information, such as whether you file jointly or separately, if you’re married and who you claim as a dependent
  • Income details for everyone in your household (even for those not applying for coverage)—including wages and salaries as reported on your W-2 form and pay stubs, net self-employment or business income, unemployment pay, social security payments, alimony, retirement and rental income
  • Best guess of your household income for the year you’ll be covered
  • Health coverage information (applies only if anyone in your household has a health plan right now)

How do I update my Marketplace application?

There are a couple of ways to do this. The easiest way is to contact your Florida Blue agent for help. If you’d like to do this yourself, follow these steps. Remember that if you change your plan in the middle of the year, you may start over with spending toward your deductible and out-of-pocket maximum. An agent can help explain this.

To apply for or re-enroll in your Marketplace coverage, call us at 1-800-352-2583.

You’ll need to provide the following information on your Marketplace application. So it’s a good idea to gather everything before you get started. Note: You won’t need all of it if you’re applying without a subsidy (tax credit).

  • Basic personal information like name and date of birth for everyone applying for coverage
  • Details about each person in your household (even those not applying for coverage)—including your spouse, children living with you and anyone you claim as a dependent on your tax return
  • Home and mailing address (if these are different) for everyone applying for coverage
  • Social security numbers for everyone on your application
  • Information about any professional who might be helping you apply, such as a navigator, agent or broker
  • Immigration document information (applies only to lawfully present immigrants)
  • Federal income tax information, such as whether you file jointly or separately, if you’re married and who you claim as a dependent
  • Income details for everyone in your household (even for those not applying for coverage)—including wages and salaries as reported on your W-2 form and pay stubs, net self-employment or business income, unemployment pay, social security payments, alimony, retirement and rental income
  • Best guess of your household income for the year you’ll be covered
  • Health coverage information (applies only if anyone in your household has a health plan right now)

What are subsidies and the Advance Premium Tax Credit?

If you purchase your own coverage for you and your family, the government may help pay a part of the cost of your health care coverage premium. The premium is the monthly cost for a health care policy. The government help is called a “subsidy.”

The subsidy is a tax credit called the advance premium tax credit and it can be applied directly to your monthly premiums, to help lower your health plan cost.

Use the Health Care Tax Credit Estimator to determine your eligibility. The government reviews information such as:

  • Your household income
  • Your family size and individual ages
  • The county where you live

The amount of financial help you get will be based on this information. If you qualify, you'll pay a lower monthly amount for your Florida Blue health plan. The government will pay the rest of it.

Talk with us one-on-one to have your questions answered. We can explain your options and guide you through the next steps to purchasing health insurance for you and your family. Contact a Florida Blue Center near you today.

Can I still get coverage if I have a preexisting condition?

Since the Affordable Care Act (ACA) was passed in 2010, everyone can get a health plan now, no matter what their health history is. Preexisting conditions will no longer apply for qualified health plans issued under the ACA.

You can buy one of the health plans, even if you are sick or have had health problems in the past. Everyone who applies for health insurance can get coverage. Once you have a health plan, your coverage cannot be canceled if you have a health problem. If you use tobacco, you’ll pay more for your health plan.

When can I sign up for a health plan?

If you get coverage through your employer, you’ll sign up for coverage as a new employee and then make changes during their yearly Open Enrollment period. If you’re not sure when your company’s Open Enrollment is, get in touch with someone in Human Resources.

If you buy your own insurance for you and your family (not Medicare), you can enroll or change plans in November and December every year. The changes you make take effect the following January or February, depending on when you apply.

Certain life events like having a baby or getting married may qualify you for a Special Enrollment Period. You can read more about that here.

When does coverage start?

If you didn’t make a payment when you applied for coverage, you’ll need to make your payment in full before your coverage will start. Look for a payment letter and a bill in the mail.

It takes up to 10 days to process your payment. If your payment is still processing when your coverage takes effect and you need care right away, there will be a few extra steps to verify your payment and coverage first.

Pay by phone or online 24/7
Call:
1-800-352-2583
Visit: http://www.floridablue.com/paynow

You can pay with a credit card, a debit card or by electronic funds transfer (EFT). Follow the prompts and select the option ‘Make a Payment.’

You'll need:

  • Member number
  • Social Security Number
  • Zip Code
  • Birthdate
  • Bank or credit card information

What do the metal levels in the Marketplace mean?

Metal categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care. Which metal category is right for you?

Bronze

·       Lowest monthly premium

·       Highest costs when you need care

·       Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.

·        Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.

Silver

·        Moderate monthly premium

·        Moderate costs when you need care

·       Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.

IMPORTANT: If you qualify for cost-sharing reductions you must pick a Silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you use a lot of care.

·        Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.

Gold

·        High monthly premium

·        Low costs when you need care

·       Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.

·        Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.

Platinum

·        Highest monthly premium

·        Lowest costs when you get care

·       Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.

 ·       Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.

Do I qualify for Marketplace coverage?

If you don’t get health insurance through your employer, you can shop for plans on healthcare.gov. To be eligible for Marketplace coverage, you:

  • Must live in the United States.
  • Must be a U.S. citizen or national (or be lawfully present).
  • Can’t be incarcerated.

Each year in early November through late December you can shop for Marketplace plans during open enrollment. This is the only time all year you can buy plans for the upcoming year unless you have certain life events like:

  • Losing other coverage
  • Getting married
  • Moving
  • Having a baby

Any of these situations may make you eligible for a special enrollment period.

Now through August 15, anyone who needs coverage can automatically qualify for a special enrollment period and purchase a Marketplace plan. You might also be able to save on your monthly amount owed.

To find out more, click here.

What are essential health benefits?

Since the passing of the Affordable Care Act in 2010, all plans must cover these 10 essential health benefits:

·       1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)

·       2. Emergency services

·       3. Hospitalization (like surgery and overnight stays)

·       4. Pregnancy, maternity and newborn care (both before and after birth)

·       5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

·       6. Prescription drugs

·       7. 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)

·       8. Laboratory services

·       9. Preventive and wellness services and chronic disease management

·       10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Plans must also cover birth control and breastfeeding.

These are the minimum requirements any health plan must offer. Florida Blue also offers many programs and services to help you achieve your best health.

What life changes qualify me for a special enrollment period for a Marketplace plan?

Generally speaking, you can only purchase new ACA policies during open enrollment periods. Open enrollment (a period of time to purchase coverage for the upcoming year) is usually in November and December.

However, certain situations can make you eligible to purchase coverage at any time. Examples include losing other health insurance, which might happen if you lose a job, getting married or divorced, having a baby or adopting a child, or moving your residence. You can call us at 844-481-3770 or visit Healthcare.gov to see if you qualify for a special enrollment period.

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