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The Marketplace was created to be very accessible to millions of people who might not have had easy access to health insurance coverage in the past. However, there are certain requirements to be met in order to purchase a plan.
To avoid being charged the individual mandate (also referred to as fee, fine, penalty, or responsibility payment), employees are obligated to obtain an insurance plan that meets the requirements of “minimum essential coverage” which include the new benefits, rights, and protections laid out in the legislation, and must remain covered throughout the year, or procure and exemption.
Insurance companies are prohibited to discriminate when offering health coverage, and there have been new restrictive measures put in place to prevent this .However, there are 5 factors that may be considered when figuring out premium costs.
The fee for no having health coverage is calculated in one of two ways, whichever amount is higher. You may be charged a flat fee or a percentage fee which will be applied to your federal income tax returns for the years that you were not insured.
If you qualify for an exemption, you will not be subject to the penalty for being uninsured. Below are some examples of exemptions that may apply to you or your family’s situation:
You can visit online to see more examples that might qualify you for an exemption from being assessed the fee for non-coverage.
A life changing event would generally involve major changes in your life that would directly affect your household income, or the gaining or losing of a family member. These events must be reported, as they could directly affect how your plan is supposed to function and could result in back pay when you file your taxes, if you fail to do so.
You can purchase a Marketplace coverage before or after you become pregnant. All plans will cover your pregnancy and also qualify you for a Special Enrollment Period (SEP) in which you can enroll in or change your coverage after childbirth. So should this occur outside of the Open Enrollment Period, it would not affect your ability to enroll or change to a different plan altogether. Once enrolled, coverage will take effect as soon as the child is born. This even applies if you fail to enroll for up to 60 days after the delivery date.
Regardless if you purchase health insurance within or outside of the Marketplace, all plans are obligated include Maternity Care and Childbirth services that cover certain essential health benefits and provide a Summary of Benefits and Coverage document explaining how the plan will cover childbirth. Again, even if you become pregnant before being enrolled in a plan, these benefits will still be available to you once you do enroll.
Medicaid and CHIP also offer these benefits and are available to low income households that meet their eligibility requirements. Both of these are state programs and will have different qualifying income levels between themselves, and from state to state. But both programs offer enrollment year round. You can apply directly through your state, or through the Marketplace.
An exception may be grandfathered individual plans that are purchased independently outside of the Marketplace or not through your employer. They may not be required to offer Maternity Care and Childbirth services.
Getting married is also considered a life changing event and, as such, must be reported. You can enroll up to sixty days after the day you get married and coverage will take effect on the first date of the month you enrolled into a plan. But you cannot enroll until after you have become married.
You may find yourself in a situation in which your non-Marketplace grandfathered plan terminates. It is important to be familiar with these scenarios and know what options you have in the event it happens to you.
If your current coverage has been changed or cancelled, you can contact a special cancellation customer service representative to go over your options at (786)683-5373 Monday through Friday from 9 a.m. to 7 p.m., Saturday and Sunday from 9 a.m. to 5 p.m. Eastern Time.
Since the advent and implementation of the ACA legislation, much energy and focus has been put into making applying, enrolling, and purchasing health insurance coverage a simple and convenient process. Healthcare.gov was the internet portal created to answer questions, provide assistance, and allow you access to purchase a health plan. There are four ways in which you can apply for coverage through the Marketplace and any of these methods can be used, whichever is most comfortable and convenient for you.
Real Time Health Quotes has been verified as an approved Health Insurance Provider qualified to offer ACA / Marketplace Plans by Verisk Financial – G2.
Health Enrollment licensing information can be found here.
Realtimehealthquotes.org is not affiliated with or endorsed by the United States government or the federal Medicare program.