Health Insurance Marketplace

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Formerly called the Exchange, this is where individuals and families can get the tax credits.

Overview

One of the most important components of the Affordable Care Act is the Health Insurance Marketplace, originally called the Exchange. The Marketplace is an online shopping portal that allows consumers to shop for qualified plans and to apply for financial assistance in the form of premium tax credits and cost-sharing subsidies. The site also allows consumers to apply for government programs like Medicaid and the Children’s Health Insurance Program (CHIP).

Under the law, each state is required to develop its own marketplace site for individuals as well as an exchange site for small employers, called the SHOP Exchange. In states that choose not to develop their own exchange, the federal government will do it for them. In total, there are 17 State-based Marketplaces; 7 Partnership Marketplaces; and 27 Federally-facilitated Marketplaces. More info here. The federally-facilitated marketplace site is Healthcare.gov.

The Healthcare.gov shopping portal went live October 1, 2013, the start of the 6-month initial enrollment period, but the site was immediately plagued with technical glitches, so the initial enrollment was far less than the administration anticipated or hoped. While still far from perfect, the site is working much better now and enrollment has increased significantly.

In states that deferred to the federally-facilitated exchange, brokers who are assisting their clients have the option of selling plans through the Healthcare.gov site (the marketplace pathway) or directly through the insurance company (the issuer pathway). And web brokers who have a contract with HHS can even enroll individuals directly through their website. In any event, the subsidy portion of the application does funnel through the Healthcare.gov site. Licensed agents who would like to sell marketplace-based plans must complete a four- to six-hour online certification course through CMS.

Regulations and Guidance

HealthCare.gov
Official consumer site for the marketplace
Marketplace.cms.gov
Resources for professionals preparing for the marketplace
Marketplace Outreach Timeline
Ongoing outreach: Digital Media, Public Events, Engaging Partners (06/24/2013)
HHS Guidance: Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces
This document provides an overview of the role of agents and brokers, including web-brokers, in Federally-facilitated Marketplaces and State Partnership Marketplaces and addresses common questions raised by states and other stakeholders on the role of agents and brokers in all Marketplaces – including State-based Marketplaces. (05/01/2013)
About the Health Insurance Marketplace | en español
7 things consumers can do to get ready now (December 2012)
The Value of Health Insurance | en español
5 things to know about health insurance (December 2012)
About the Small Business Health Options Program (SHOP) | en español
7 things you can do to get ready now (December 2012)

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