The Health Insurance Marketplace
This information is also available in Spanish.
Between November 1, 2015 and January 31, 2016, people who need to buy health insurance on their own can shop for health coverage on a website called a health insurance marketplace (also called a health insurance exchange). This includes eligible cancer patients, cancer survivors, and their families.
Through the marketplace, people can compare health plans by the amount of coverage they offer and price. All plans sold in the marketplaces cover essential health care and cannot deny coverage to people with pre-existing conditions like cancer.
Health plans bought in the marketplaces can take effect as early as January 1, 2016.
What is a marketplace?
The health care law known as the Affordable Care Act requires each state to offer an online health insurance marketplace where people can shop for plans and compare plans by benefits, quality, and price. Information on all the marketplaces is available at www.healthcare.gov/ or www.CuidadoDeSalud.gov.
The health care law requires that information about prices and what a plan covers be written in simple terms that are easy to understand, so there’s no guessing about costs. People can get a clear picture of what they’re paying for and what they’re 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 or a family member loses a job or health insurance benefits, you may be able to sign up for a health plan through the insurance marketplace in your state that might be more affordable.
Will my insurance cover everything I need for cancer treatment and follow-up?
The health care law allows more people with cancer and cancer survivors to get the health care they need by requiring all health plans sold in the marketplaces to cover essential benefits. These include coverage for cancer screening tests, treatment, and follow-up care.
Many health plans are offered, and they’ll differ on which doctors and hospitals they cover. Be sure to check with the plan you pick to make sure it covers the doctors and hospitals you need for your cancer treatment and follow up.
By law, insurance plans offered through the marketplaces cannot deny coverage to anyone because of pre-existing conditions like cancer. And all insurance plans must provide basic benefits that cover things like doctor’s visits, hospitalizations, preventive care, and prescriptions. While each plan offers a similar set of benefits, what you pay will vary depending on the plan.
Will I be able to afford a plan?
Plan categories or groups
Each marketplace labels the health plan groups, as platinum, gold, silver, bronze, or catastrophic. Plans in each group differ based on how you and the plan share the costs of your care. The groups have nothing to do with the amount or quality of care you get.
For instance, bronze plans are the cheapest, but they pay on average only 60% of the cost of a medical service like a doctor’s visit or surgery. This means you must pay as much as 40% of the cost. Silver, gold, and platinum plans cost more, but you pay less of the cost of care as the levels go higher.
Catastrophic coverage plans generally pay less than 60% of the total cost of care – and only after you’ve paid all the costs of your care up to a certain amount. They’re available only to people who are under 30 years old or have a hardship exemption.
When shopping for a new health plan it’s important to look at what the plan covers and what you’re expected to pay – not just the premium – to make sure you understand the total cost of the plan and be sure that you’re getting the one that best meets your needs.
Finding out if you can get help paying for a plan
The marketplaces 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 $$46,680 per year and families of 4 with a combined income of up to $95,400 per year should be able to get financial help buying 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 or www.CuidadoDeSalud.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. Unfortunately, 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 won’t qualify for help paying for insurance in the marketplace, either. If this happens to you and your income later goes up (above the poverty level), you should check with the marketplace right away to find out if you now qualify for help buying private insurance and ask when you can apply again through the marketplace. If your income drops or your situation changes, you can re-apply for Medicaid at any time. To find out if your state has broadened access to Medicaid coverage, visit www.healthcare.gov or www.CuidadoDeSalud.gov.
Costs and terms you need to know
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’ll have to pay, including:
- premium: The monthly amount you pay the insurer for health coverage or the amount of your monthly bill.
- deductible: The amount you pay in a calendar year before the plan pays.
- A flat dollar amount you pay for a covered service, each time that you use the service.
- The percentage of the cost of the total service you must pay.
How/when do I sign up?
Open enrollment starts November 1, 2015. Although open enrollment ends January 31, 2016, people with certain qualifying events, such as the loss of a job, legal separation, divorce, or the birth of a child, can still enroll in a marketplace plan after open enrollment. These special enrollment periods only last for 60 days after the event, so you’ll need to act quickly.
Where can I get help?
You can learn more through the Health Insurance Marketplace toll-free call center at 1-800-318-2596 or TTY 1-855-889-4325 – both of which are available 24 hours a day, 7 days a week. Callers can get information in several languages.
You can use the website https://localhelp.healthcare.gov to find people in your community who can help you apply, enroll, or give you answers to any questions you might have.
The American Cancer Society Cancer Action Network has facts and tip sheets about health insurance at www.acscan.org/healthcare/learn/.
No matter who you are, we can help. Contact your American Cancer Society anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.
Last Revised: 04/09/2015