Every year on November 1st, the health insurance marketplace opens up for Utahns to enroll in insurance coverage. Unlike Medicaid, healthcare.gov has an open enrollment period, typically November 1st to December 15th. Outside of that window, enrollees would have to qualify for a Special Enrollment Period (SEP) such as turning 26, getting married or divorced, adopting or having a child, or moving to a new ZIP code.
There is free Marketplace enrollment assistance available—sign up for a free virtual enrollment assistance appointment with Take Care Utah or call 2-1-1 to be connected to free help near you.
Below are common questions asked about the Marketplace and information about where you can learn more.
Why should I enroll in the Marketplace?
Policies allowing young adults to stay on parent’s health insurance until age 26, ACA Marketplace coverage, and Medicaid expansion have all contributed to reduced uninsured rates for young adults.
As a student, you’ve got a lot on your plate, like housing, picking your major, exams, and how COVID 19 impacts you. Having health coverage ensures that while you’re navigating all of this, if you need Mental Health services or if injury or illness befalls you, you’ll have coverage in place to keep you secure.
Marketplace coverage is administered by the Federal Government and is available to individuals who:
- Live in the United States;
- Are a US citizen or national (or be lawfully present. DACA does not qualify);
- Aren’t currently incarcerated; and
- Aren’t enrolled in Medicare or eligible for Medicaid (see Medicaid eligibility article here).
The amount of help you receive through the Marketplace to pay for your health insurance largely depends on your income and household size.
How can I apply?
The health insurance Marketplace has an open enrollment period from November 1st-December 15th, 2020. Anyone can apply for coverage during this window, or if they’re already enrolled in a Marketplace plan they can review or change their plans from last year.
If you are trying to apply outside of the open enrollment period, and individual must qualify for a Special Enrollment Period.
There are a few pieces of information you’ll need to apply for Marketplace coverage (For comprehensive list of items needed click here):
- Names, dates of birth, and Social Security Numbers for all those applying;
- Estimated annual household income (to see if you qualify for a discount); and
- Information about health insurance offered through your job (if applicable).
There are two key ways to apply for Marketplace coverage:
- With nonprofit assistance: Take Care Utah (TCU) is a nonprofit helping indivduals apply for Medicaid, CHIP, and Marketplace coverage for free. TCU is statewide and can help people in several languages. Find free help at org, call 2-1-1 to be referred to someone near you, or book a free virtual enrollment appointment here.
- On your own: You can apply for Marketplace coverage online at: healthcare.gov or call 1-800-318-2596
What about benefits?
All plans offered in the Marketplace must cover these essential health benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
- Birth control coverage
- Breastfeeding coverage
Plans may also offer additional benefits including:
- Dental coverage
- Vision coverage
- Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, you’ll see exactly what each plan offers.
Does Marketplace cost money?
Whether an individual qualifies for subsidies on healthcare.gov really depends on where they fall on the Federal Poverty Level (FPL). Individual’s whose incomes are between to 138% and 250% FPL are eligible for cost sharing reductions and are more likely to qualify for affordable options including plans with $0 premiums and $0 deductibles (incomes highlighted in yellow below).
More than 80% of Utahns enrolled in Marketplace coverage last year qualified for some type of financial assistance, and approximately 2 in 3 healthcare.gov applicants can find a plan with a $10 monthly premium. This sliding-scale cost assistance is available for individuals and families up to 400% FPL.
|Eligible for Cost Sharing Reductions|
|Household / Family Size||138%||150%||200%||250%||300%||400%|
For families with more members, add $6,182 for each additional person.
There are special cost sharing protections in place for American Indians and Alaska Natives—find out what those are here.
If your income falls below 138% FPL, you should apply for Medicaid.