+ -Text Size

The Health Insurance Marketplace

The new health care law will give some cancer patients, survivors, and their families – as well as others who need to buy health insurance on their own –the opportunity to shop for a plan on a website called a health insurance marketplace (also called a health insurance exchange). People will be able to compare health plans by the amount of coverage they offer and price. All plans sold in these marketplaces will cover essential health care and won’t be able to deny coverage to people with a pre-existing condition such as cancer. Health plans sold in the marketplaces will take effect Jan. 1, 2014.

What is a marketplace?

Beginning in October 2013, each state will have an online health insurance marketplace that allows people looking for coverage to shop for plans and compare them by benefits, quality, and price. The health care law requires that information about prices and what a plan covers must be written in simple terms that are easy to understand, so there’s no guessing about costs. People will get clear picture of what they are paying for and what they are getting before making a choice.

Am I eligible for the marketplace?

If you are under 65 and don’t have access to health coverage through your employer* or Medicare, you can buy a health plan through the insurance marketplace in your state. If you like your work health plan and want to keep it, you don’t need to buy insurance through the marketplace. If you or a family member loses a job or health insurance benefits, there will be new options that may be more affordable to you.

*People with health care through their job whose monthly premiums are too high compared to their income may be eligible for financial help in affording a plan sold on their state’s marketplace.

Will it cover everything I need for cancer treatment/follow-up?

The health care law allows more cancer patients and survivors to get the health care they need by requiring all health plans sold in new health insurance marketplaces to cover essential benefits. These include coverage for cancer screening, treatment, and follow-up care. The marketplaces will offer a variety of plans, and eligible people will be able to choose one that works best for them.

By law, insurance plans will not be able to deny coverage to anyone because of pre-existing conditions like cancer. All insurance plans must have basic benefits that will cover things like doctor’s visits, hospitalizations, preventive care, and prescriptions. While each plan will offer a similar set of benefits, what you pay will vary.

Will I be able to afford a plan?

Each marketplace will put the health plans into groups (platinum, gold, silver, or bronze) based on the cost of the plan. While bronze plans will have the lowest monthly premiums, they will only pay 60 percent of the cost of a medical service like a doctor’s visit or surgery, leaving you responsible for as much as 40 percent of the cost. Silver, gold and platinum plans will have higher monthly premiums, but you will pay less of the cost of care.

The marketplace will help people figure out if they qualify for help paying for health insurance or if their income makes them eligible for state programs such as Medicaid. Most people who make up to $45,960 per year and families of 4 with a combined income of up to $94,200 per year should be able to get financial help to buy a health plan through the marketplace. Depending on your income, you may also qualify for financial help to limit your out-of-pocket costs for medical services. Tax credits can be taken in advance to reduce monthly premiums or as a refund at tax time. For details on whether you qualify and for how much, visit www.healthcare.gov.

Under the health care law, states have the option to give everyone below a certain income level access to health coverage through Medicaid. Several states have done so, but not all. In states that have not broadened access to Medicaid coverage, many low-income people will not qualify for Medicaid. Some of the poorest of these people also won’t qualify for help paying for insurance in the marketplace.

When deciding which plan is right for you, it’s important to not only look at the benefits offered, but also the total amount you will have to pay, including:

  • Monthly premium – The monthly amount you pay the insurer for health coverage.
  • Annual deductible – The amount you pay in a calendar year before the plan pays.
  • Co-Pays - A flat dollar amount you pay for a covered service, each time that you use the service.
  • Co-Insurance -- The percentage of the cost of the total service you must pay.

How/when do I sign up?

Enrollment starts October 1, 2013 and coverage begins January 1, 2014. Enrollment closes for the year March 31, 2014. You can enroll through www.Healthcare.gov/Marketplace, or find your state marketplace by calling this toll-free number 1-800-318-2596.

Where can I get help?

Information is available online through www.healthcare.gov and www.GetCoveredAmerica.org. You can also learn more through a toll-free call center at 1-800-318-2596. Callers can get information in multiple languages.

In-person help at community health centers, libraries, hospitals and other such places will be available to help people apply online or by mail. These people can help you find out if you’re eligible and help you enroll.

Last Medical Review: 07/25/2013
Last Revised: 07/25/2013