If you don’t have access to health insurance coverage through an employer, you’ll be able to enroll in coverage either through the exchange marketplace or outside the exchange marketplace as you do today. There are advantages to both of those options, depending on your circumstances, and there are resources to help you consider your choices and find the right coverage. If you’re currently uninsured, you’ll need to enroll in coverage during an open enrollment period or a special enrollment period.
The Exchange Marketplace: The best choice if you qualify for financial assistance
The exchange marketplace application includes detailed financial questions to determine your eligibility for financial assistance. If you qualify for premium assistance, you’ll be able to choose any plan available through the exchange marketplace and apply your financial assistance toward that plan’s premium cost. If the plan you choose costs more than your premium assistance, you’ll be responsible for paying the difference. For example, you may qualify for enough premium assistance to fully pay for a Bronze plan, but choose to use your own dollars to “upgrade” to a Silver or Gold plan. If you’re eligible for a cost share subsidy, you’ll need to enroll in a Silver plan to access that assistance.
You can choose to shop for health insurance through the exchange marketplace even if you don’t qualify for financial assistance, but you’ll find more options available outside of the exchange marketplace.
The existing marketplace: More choice and less complexity
If you don’t qualify for financial assistance, you may find advantages to purchasing coverage direct from an insurance company, without using the exchange marketplace. That’s especially true if you already have an individual policy and you’d like to stay with the same health insurance company.
On the existing market you’ll have access to all the plans available through the exchange marketplace (and at the same rates), plus additional options.
If you already have an individual policy and want to stay with the same insurer, you’ll find it easier to do so outside the exchange marketplace. You will likely be able to move to a new metal level plan with your current insurer without completing a new application form. You’ll also likely have uninterrupted access to your insurer’s member services, such as claims history, wellness tools, and condition support programs.
Need help sorting things out?
If finding the right coverage on your own seems overwhelming, don’t worry—help is available. Independent agents and brokers—the insurance consultants you likely use today—continue to be a resource to people shopping for individual or family coverage. Agents who receive training and are certified through the exchange marketplace can help you find coverage either inside or outside the exchange marketplace. Theycontinue to receive commissions as they do today, and state laws ensure that there’s no financial incentive for them to steer customers either to, or away from, the exchange marketplace.
Many insurers, including PacificSource, have dedicated teams of employees to assist customers with choosing healthcare coverage that is best for them.