Marketplace Health Insurance Plans: FAQ’s Answered

By Nancy Boyd, Director of Billing/RCM Operations, ClearlyMD.

Do you have questions about the marketplace health insurance plans? Here are some facts:

  • In 2014, most Americans are required to have health insurance or pay a per-month fee on their taxes for every month they went without insurance coverage
  • Open enrollment begins November 15th of each year
  • No one can be denied coverage for health-related issues
  • Marketplace is open to all Americans but no one is required to use it. Plans may still be purchased from private health plans or through a broker
  • If you get insurance through an employer, you may still be able to use the marketplace to see if you are eligible for tax credits
  • Plans cost less than 8% of your family income while most insurance obtained through an employer can cost up to 9.5%
  • Premiums are based on income, age, tobacco use, family size, geography, and type of plan you buy
  • Individuals and families earning less than 400% of the federal poverty level annually get cost assistance
  • Small businesses with fewer than 50 full-time equivalent employees can use the marketplace to purchase insurance coverage for their employees
  • 4 ways to apply: in person, by phone, paper application, or online
  • is a one-stop shop to apply for coverage, compare plans, and shop for the best plan without having to use a broker
  • By October 1, 2013, each state was required by law to have a new online marketplace where residents could buy health insurance. Most states will offer 5 tiers of plans- Catastrophic, Bronze, Silver, Gold, and Platinum. (Most are expected to purchase Silver.)
  • Tennessee’s participating plans:

BCBST- offers PPO plans in the Bronze- Platinum tiers

Cigna- offers PPO plans in the Bronze – Gold tiers

Community Health Alliance- offers Catastrophic plans – Gold tiers

Humana offers PPO plans in any tier

  • Mississippi’s participating plans:

Humana- offers PPO plans in any tier

Ambetter from Magnolia- offers HMO plans Bronze-Gold

  • Other States participating plans:

BCBS is currently the only payer offering Multi-State Plans. Multi-State
options are curretnly offered in thrity states.

Insurers are allowed to phase in coverage, with 60% of the states in year one, 70% in year two, 85% in year three, and 100% in year four and each subsequent year.