Health Insurance Marketplace
The Health Insurance Marketplace (Marketplace) is a federally operated insurance marketplace (or exchange) where individuals and small businesses shop for and compare health coverage. The Marketplace is primarily accessed as a website: www.healthcare.gov. However, a paper application and consumer assistance is available at the Marketplace Call Center 800-318-2596 or by contacting a local assister.
Open Enrollment for the Health Insurance Marketplace:
Open enrollment for coverage in 2019 is November 1, 2018 through December 15, 2018. Plans purchased during open enrollment will become effective January 1, 2019. This is the only time to purchase a health plan for 2019 unless you qualify for a special enrollment period.
Purchasing Coverage in the Health Insurance Marketplace:
Any individual or family may buy coverage in the Marketplace. (Illegal or undocumented immigrants and incarcerated people cannot purchase coverage in the Marketplace.) For those who do not want to purchase in the Marketplace, coverage will continue to be sold outside of the Marketplace during open enrollment. Plans sold outside of the Marketplace may be purchased through a licensed agent or directly from a health carrier. However, the advanced premium tax credit (APTC) and cost-sharing reduction (CSR) benefit are only available to those who qualify and purchase a health plan in the Marketplace.
However, if you are uninsured, purchased individual coverage last year that is or is not being renewed in 2019, or believe your coverage is inadequate or unaffordable, you may wish to apply to the Marketplace during open enrollment to review 2019 health plans and find out if you qualify for an APTC or CSR to help with the cost of coverage.
Health Coverage Requirement:
The “individual mandate” provision of the ACA requires that people obtain health insurance or pay a federal tax penalty, for plan years 2018 and earlier. If you currently have coverage from the Healthy Michigan Plan, Medicare, Medicaid, an employer or you have a major medical plan that you purchased yourself, you are considered covered and will not pay a tax penalty.
Those who were uninsured for more than two months in 2018 may pay a federal tax penalty of $695, plus an inflation adjustment to be determined, or 2.5% of their household income.
You may be exempt from paying the penalty for not having coverage if you were uninsured for only one or two months, experienced a financial hardship, religious or moral objection, belong to a Health Care Sharing Ministry, or if it would cost more than 8.05% of your income in 2018 to purchase coverage. The Marketplace provides more information about the exemptions from the requirement to have health insurance.
NOTE: Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the Shared Responsibility Payment no longer applies.
Cost of Coverage in the Health Insurance Marketplace:
To apply for coverage and to view plans sold in the Marketplace go to www.healthcare.gov. To get an estimate of what your premiums might be, please visit the Marketplace’s Premium Estimator. The premium estimates do not represent an offer of coverage in the Marketplace.
Help with the Cost of Coverage in the Health Insurance Marketplace:
Advanced premium tax credits (APTC) are available to assist with the cost of health coverage in the Marketplace for those with income between 100 percent and 400 percent of the federal poverty level who are not eligible for other affordable coverage.
The federal poverty level is adjusted annually. In 2018, 400 percent of the poverty level for Michigan residents is $48,560 for an individual or $100,400 for a family of four. The 2018 federal poverty level applies to plans purchased for the 2019 plan year.
Cost-sharing reductions (CSR) are available to individuals that purchase a silver plan in the Marketplace and are up to 250% of the federal poverty level. Those eligible for a CSR silver plan will experience lower out-of-pocket costs, such as lower deductibles, copayments, and coinsurance.
Healthy Michigan Plan:
Some Michigan residents may be eligible for the Healthy Michigan Plan. To be eligible for the Healthy Michigan plan, you must be:
- Ages 19-64
- Not currently eligible for Medicaid
- Not eligible for or enrolled in Medicare
- Not pregnant when applying for the Healthy Michigan Plan
- Earning up to 133% of the federal poverty level
- The federal poverty level is adjusted annually. In 2018, 133% of the poverty level for an individual was $16,146 or $33,383 for a family of four
- A resident of Michigan
Types of Plans Available in the Marketplace:
Four tiers of coverage are available through the Marketplace:
- Expanded Bronze Level – This plan must cover between 56% and 62% of expected health care costs.
- If an expanded bronze plan covers and pays for at least one major service, other than preventive services, before the deductible, or meet the requirements to be a high deductible health plan, it must cover between 56% and 65% of expected health care costs.
- Bronze Level - These plans must cover 60% of expected health care costs.
- Silver Level - These plans must cover 70% of expected health care costs.
- Gold Level - These plans must cover 80% of expected health care costs.
- Platinum Level - These plans must cover 90% of expected health care costs.
One additional level of coverage is available in the Marketplace: a catastrophic plan. Catastrophic plans are available only to people under age 30 or to people of any age who have received certain hardship exemptions. Catastrophic plans generally have lower premiums and higher deductibles. Marketplace catastrophic plans cover three annual primary care visits and preventive services at no cost. People with catastrophic plans are not eligible for federal tax credits to lower their monthly premiums.
Plans for Sale in the Marketplace:
To get a listing of plans sold in the Marketplace by geographic area and sample prices, visit DIFS’ Company Premiums by Metal Level/Age comparison chart.
Cost for Coverage for People with Pre-Existing Conditions:
Plans cannot deny you coverage, charge you more, or impose a waiting period on your coverage because of a pre-existing medical condition.
Individual health insurance premiums (both on and off the Marketplace) can only vary based on household size, the geographic area that you live in, your age, and tobacco use.
Help Signing up for Coverage:
If you are in need of In-Person Consumer Assistance with the Marketplace, there is assistance available through licensed health insurance agents, navigators, and certified application counselors in your area.