Top Questions

  • I heard my state isn’t creating a “marketplace.” How can I get coverage?

    No matter what state you live in, you can visit the Health Insurance Marketplace to shop for and purchase coverage. Some states are creating their own marketplaces while others are using the Marketplace created by the federal government. Click here to find out what your state is doing.

  • Can I sign up for coverage outside of open enrollment?

    If you missed open enrollment, you may still be able to enroll if you experienced a “qualifying life event.” A Special Enrollment period allows you and your family to enroll in health coverage after a “qualifying life event” such as:

    You move outside your insurance plan’s service area.

    • You get married.
    • You have a baby or adopt a child.
    • You lose other health coverage due to job loss, reduced work hours, or COBRA coverage ends.
    • You become a U.S. citizen.
    • You leave incarceration.
    • You are a member of an American Indian or Alaska Native tribe. (You can enroll in Marketplace coverage any time of year. You can change plans up to once a month.)
    • You are no longer covered on a family member’s policy because
      • you turned 26,
      • you have legally separated from or divorced your spouse,
      • or the policyholder has passed away.
  • Is there a penalty if I do not enroll in health insurance?

    Since unexpected issues happen to everyone, having health insurance can actually save you money. Also, if you do not get insurance coverage for 2018, you may be subject to a penalty on your tax return. This fee is either 2.5% of your yearly household or $695 per adult, whichever is higher. For children under the age of 18 the fee is $347.50. You’ll pay the fee on your 2018 federal income tax return. Most people will file this return in 2019.

    Some Americans who remain uninsured will qualify for exemptions. If you are without insurance for less than 3 months, you don’t have to pay a penalty. You may qualify for an exemption from the penalty if:

    • You don’t have to file a tax return because your income is too low
    • You’re a card-holding member of a federally recognized tribe or eligible for services through an Indian Health Services provider
    • You’re a member of a recognized health care sharing ministry
    • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
    • You’re incarcerated (either detained or jailed). You’re not lawfully present in the U.S.
    • You qualify for a hardship exemption such as filing for bankruptcy or being homeless, evicted in the past 6 months or facing eviction or foreclosure.
  • What do I need to know about the health care law?

    • You may have been turned down by a health plan, received limited coverage or were asked to pay more. Unless they were part of a group, many people who had a pre-existing health issue were not able to get an affordable health benefit plan before the health care law. That changed under the Affordable Care Act. If you have a health issue before you apply for insurance—it will not stop you from getting coverage.
    • Parents can keep adult children on their insurance plan. Most limits to keeping your young adult children, up to 26 years old, on your coverage have been removed, meaning they don’t have to be a full-time student, live with you, disabled or a tax dependent.
    • Preventive screenings and services are now covered. It can be challenging to maintain your health without continuous care. Each qualified health insurance plan covers preventive services at no added cost to you when you use a network provider.
      • This includes services like yearly wellness exams, recommended vaccines for children and adults, mammograms, blood pressure screenings, osteoporosis screenings, type 2 diabetes screenings for adults with high blood pressure, adult obesity and tobacco use screenings.
    • Your insurance cannot be canceled because of your health status. You will not be dropped from your insurance just because you are sick.
    • There are no dollar limits on the care you receive for essential health. Your coverage cannot have a dollar limit on essential health benefits while you’re enrolled in that plan.

    Learn More

  • How does the Health Insurance Marketplace work?

    You can go online at healthcare.gov or call 1-800-318-2596 to learn about health insurance plans available in your area. Plans on the Marketplace will offer comprehensive health coverage, from doctors to medications to hospital visits.

    You can compare all your health insurance options based on price, benefits and other features that may be important to you, in plain language. You can apply for coverage online, over the phone or with a paper application. Open enrollment is November 1, 2017 through January 31, 2018 for coverage starting in 2018.

    All plans on the Marketplace have similar benefits, and all include a comprehensive package of health benefits. Where they differ is on how the costs of the benefits are applied. Plans on the Marketplace are divided into four different levels—Bronze, Silver, Gold and Platinum.

    Learn More

  • How much do the plans cost?

    All insurance plans available through the Marketplace are offered by private insurance companies. Prices are approved by state insurance departments and/or the federal government. When you use the Marketplace to compare plans you’ll see prices for all plans available to you. Prices will show any cost savings you may be eligible for based on your income. These lower costs are available only through the Marketplace.

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  • I have COBRA. When it runs out, can I buy a plan on the Marketplace?

    Yes, you can even purchase a plan on the Marketplace before COBRA runs out. When you leave a job, you may be able to keep your job-based health coverage for a period, usually up to 18 months. This is called COBRA continuation coverage.

    You may change from COBRA coverage to Marketplace health insurance coverage any time. Losing your COBRA coverage qualifies you to buy health insurance on the Marketplace, even if it’s not during open enrollment. At any time during the year you can visit the Marketplace to find your options, compare plans and enroll.

  • Can I choose my own doctor or keep my old one?

    The health plans offered through the Marketplace have provider “networks.” Networks are the groups of hospitals, doctors, pharmacies and other health professions that the insurance company offering the coverage works with. Your doctor may or may not be included in this network, but your insurance may provide coverage for non-network providers. If keeping your doctor is important to you be sure to check if he or she is on the insurance plan you’re considering buying and if the plan provides coverage for out-of-network providers.

  • What preventive services does the health care law cover?

    Each qualified health insurance plan covers preventive services at no added cost to you when you use a network provider. Here are some of the benefits you can expect in your plan:

    • Yearly wellness exams
    • Recommended vaccines for children and adults (including flu shots)
    • Mammograms, blood pressure and osteoporosis screenings
    • Diabetes (type 2) screening for adults with high blood pressure
    • Adult obesity and tobacco use screenings
  • Can I get dental coverage through the Marketplace?

    Yes, you can get dental coverage two different ways when you sign up for new coverage. You may be able to find plans that include a dental plan while shopping. If your plan includes health and dental you will only have to pay one premium. If you can’t find a health plan you like that also has dental, you can opt for a stand-alone dental plan. This separate plan will require a separate premium payment.

  • Do I qualify for help paying for my insurance?

    If you have had difficulty affording health insurance, go online or call the Marketplace to determine if you are eligible for a government insurance program, or tax creditsand financial assistance to help pay for coverage.

    When you shop on the Marketplace, you may qualify for a premium credit that will lower your monthly insurance cost. Depending on your situation, you may even be eligible for a $0 premium plan. You’ll be able to see what your health insurance premium, deductibles and out-of-pocket costs will be before you make a decision to enroll.

    You may qualify for lower costs on monthly premiums. It depends on the size of your family and the size of your household income. Typically, people at lower income levels will qualify for higher subsidies. When you apply for health insurance and fill out your application you will be able to see prices that show any savings you qualify for.

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  • I’m a senior. How has the Affordable Care Act affected my Medicare?

    Your Medicare benefits are secure

    • Under the health care law, your guaranteed Medicare-covered benefits aren't reduced or taken away.

    You can choose your doctor

    • The law does not change how you select your own doctor. Youcontinue to choose your doctors based on Medicare guidelines. If you are enrolled in a Medicare Advantage Plan or group health plan, different rules may apply. Check with your plan provider for details.

    More preventive services are covered

    • Under the Affordable Care Act, Medicare covers certain preventive services, with no added out-of-pocket cost for care such as flu shots, mammograms, osteoporosis screening and immunizations.

    You can compare nursing facilities and services at home

    • Skilled nursing facilities publish information about the owners and how they operate to help people compare services.
    • High-needs Medicare patients have access to basic health care services in their homes. This will help prevent hospital stays and improve their satisfaction.
  • I’m a woman. What preventive services does the health care law cover?

    Qualified health plans cover screenings and services essential to women with no out-of-pocket costs. Simply visit a doctor in your health plan’s provider network. Here are some of the essential benefits:

    • Mammograms and pap smears
    • Interpersonal and domestic violence counseling
    • Counseling and screening for HIV
    • Immunizations such as the annual flu shot
    • Breastfeeding support, supplies and counseling
  • What changed for kids and young adults under the new health care law?

    Kids now have more options for insurance. Health coverage is available for all kids, even those with medical conditions.

    Young adults can stay on their parent’s health plan up to age 26. Most limits to keeping your young adult son or daughter on your coverage were removed, meaning they don’t have to be a full-time student, live with you, be disabled or be a tax dependent.