Common Questions Asked About The Insurance Marketplace
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Marketplace plans can be purchased in the following circumstances:
During the Open Enrollment Period
During a Special Enrollment Period
If you are eligible for Medicaid or CHIP
If you applied for Medicaid or CHIP during open enrollment and find out you're ineligible after open enrollment ends
If you are Native American
NY, MN, and MA residents with "fairly low income"
The Open Enrollment Period is the yearly period in the fall when you can enroll in a health insurance plan via the Insurance Marketplace on healthcare.gov for the next calendar year. Open Enrollment occurs at the end of the year November 1 through December 15 (sometimes ending at a later date, as this end date varies by state). Once you enroll, your new insurance coverage will begin on January 1 of the New Year.
With a Special Enrollment Period, you must have qualifying life event for an individual or family to purchase health insurance outside of the annual ACA open enrollment period. Examples of qualifying life events are loss of other insurance coverage, the birth or adoption of a child, marriage, divorce, moving, or certain other life changes. If eligible, you may qualify for help paying for coverage, even if you weren’t eligible in the past. There is a 60-day window through the marketplace that triggers a special enrollment period when an individual experiences a qualifying life event. For Medicare coverage, most qualifying events trigger 2-month special enrollment periods, but there are exceptions.
*Although loss of existing minimum essential coverage is a qualifying event that triggers a special open enrollment period for ACA-compliant individual market plans, short-term policies are not considered minimum essential coverage, so the loss of short-term coverage is not a qualifying event.
Through Medicaid or the Children's Health Insurance Program (CHIP), You can apply any time and can enroll immediately if you're eligible. If you are denied coverage and deemed ineligible for Medicaid or CHIP after open enrollment ends, you will be able to apply for a new insurance plan through the Marketplace.
To be eligible as a Native American for open enrollment, you must be a member of a recognized Indian tribe, band, or nation, according to the Indian Healthcare Improvement Act.
New York (the Essential Plan) and Minnesota (MinnesotaCare) both offer year-round enrollment and are available to residents with income up to 200% of the poverty level.
Massachusetts (ConnectorCare) is available to residents with income up to 300% of the poverty level.
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You can report changes to the Marketplace 3 ways: online, by phone, or in person — not by mail. It's important to report any changes as soon as possible. These changes may affect your coverage and savings.
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You can upload the documents online, which is the fastest and easiest way to get them processed. Or you can mail copies instead.
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When you have Marketplace insurance, you'll pay your premiums directly to the insurance company — not to the Health Insurance Marketplace®. Your coverage won't start until you pay your first premium.
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If you are qualified for a health plan through the Affordable Care Act (through open enrollment or a qualifying life event), you can start by going to, you can apply for health coverage in several ways:
• Online at healthcare.gov
• By phone
• With the help of someone in your community
• Through an agent/broker
• Through certified enrollment partner websites
• With a paper application
• The most common, and easiest, way to review and choose a health plan is to go to healthcare.gov. This will allow you to visually view health plans side-by-side to compare coverage.
Health Plan Categories (Plans will be available and vary by income):
Bronze Plan – Estimated to cover 60% of medical bills, leaving the insured member to pay the remaining 40% up to established out-of-pocket maximum.
Silver Plan – Estimated to cover 70% of medical bills up to established out-of-pocket maximum.
Gold Plan – Covers 80% of medical bills up to established out-of-pocket maximum.
Platinum Plan – Estimated to cover 90% of medical bills up to established out-of-pocket maximum.
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Yes, though there are certain circumstances to qualify for insurance through the Marketplace. Click here to learn more.
Step-by-Step Guide to apply for insurance on the Marketplace:
Apply online by going to healthcare.gov
Click on “See If I can Enroll”
If you are not sure if you qualify, you can type in your zip code to see if you qualify to change or add new health coverage in a special Open Enrollment Period. If it is an Open Enrollment Period (these dates will be available on the website), you should be able to qualify for new coverage.
Once entering your zip code, you will be routed to the appropriate page for your state.
The shop and compare tool will allow you to search for different monthly premiums, preferred providers, and eligibility for financial help towards your health insurance.
You then will be prompted to create an account, if you do not already have one, and complete an application for eligibility, being Open Enrollment or a qualifying life event—the site will show eligible life events to choose from.
Once completing your application and confirming your eligibility, you will click on “Shop for Plans.”
All plans within your eligibility will appear on the site. You have the option to enter in your providers, to see if they accept the available health policies, and to filter preferences to narrow down the plans.
Once choosing one that works best for you, you will select the plan, pay your first month’s premium, and set up a way to continue paying monthly.
This can be a difficult and overwhelming decision. If you feel you need additional guidance before selecting your plan and would like to ask some questions, you may call 1-800-318-2596 or (TTY 1-855-889-4325) – available 24/7, other than on holidays.
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You must:
Live in the United States
Be a US citizen or national, or be lawfully present in the US
Not be incarcerated, though you can enroll once you are no longer
Not have an active Medicare plan
You can have both a Marketplace plan and Medicaid, but you're not eligible to receive advance payments of the premium tax credit or other cost savings to help pay for your share of the Marketplace plan premium if you are enrolled in Medicaid.
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If you are qualified for a health plan through the Affordable Care Act (through open enrollment or a qualifying life event), you can start by going to, you can apply for health coverage in several ways:
Online at healthcare.gov
By phone
With the help of someone in your community
Through an agent/broker
Through certified enrollment partner websites
With a paper application
The most common, and easiest, way to review and choose a health plan is to go to healthcare.gov. This will allow you to visually view health plans side-by-side to compare coverage.
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With ACA plans through the insurance marketplace, you can’t be denied coverage or denied the minimum 10 essential health benefits these plans must cover. ACA plans can offer additional benefits, but these 10 must be included in any ACA-compliant plan. You cannot apply for ACA-compliant medical plans at any time of year. To apply for one of the ACA medical plans, you must enroll during the open enrollment period or during a special enrollment period.
The 10 minimum essential health benefits are:
Outpatient care
Prescription drugs
Emergency services
Mental-health and addiction treatment
Hospitalization
Rehabilitative services and devices
Preventive, wellness, and chronic disease treatment
Laboratory services
Pediatric care
Maternity and newborn care
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Project HEAL offers annual 1:1 support via phone or Zoom call to help assist in choosing a plan that will meet individual and treatment. An Open Enrollment Webinar is also located on our website here.
Out2Enroll is a "a national initiative launched in September 2013 to connect our communities—LGBTQ+ people and our families, friends, and allies—with the new health insurance coverage options available under the Affordable Care Act." Out2Enroll also lists Transgender Health Resource Guides, by state here.