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Coverage With Insurance Exchanges

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  • March 5, 2015 7:15 PM
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Insurance Exchanges Online

Health Insurance Exchanges Put Coverage within Your Reach

As part of the Affordable Care Act (ACA), a Health Insurance Exchange Marketplace was established to make it easier and more affordable for Americans to sign up for health insurance coverage. The exchanges themselves are online marketplaces where you can comparison shop for a healthcare insurer that’ll meet your specific needs and requirements, all the way down to price.

In January 2014, when ACA went into effect, it became mandatory for Americans to obtain health insurance coverage.  For those who opt not to sign up, the IRS can assess a fee known as an Individual Shared Responsibly Penalty on their Federal Tax Returns for failing to meet the “Individual Mandate,” unless they qualify for an exemption.

Enrolling on the Exchange

Each year, an Open Enrollment Period allows people to enroll in a qualified healthcare policy on the exchanges.  The most recent enrollment period extended from November 15th, 2014 through February 15th, 2015.  If you’ve missed the deadline, your next best option is signing up for a short term insurance plan outside of the marketplace. It’s important to note, however, that these plans will not exempt you from the Individual Shared Responsibly Penalty that you’ll have to pay and the likelihood is high that the plan itself will not be compliant with the rules and regulations of ACA. It’s advisable that if you find yourself in this type of situation, you spend some time learning more about exemptions, as well as potentially qualifying for a Special Enrollment Period (more on the latter below).

Procedure for Enrolling

In order to enroll, you must first create an account.  Best practice is to not try to enroll on the first day enrollment is open or the last few days it’s set to close, since the exchanges themselves have been known to crash, making for countless headaches that could likely be avoided with a little pre-planning.

You’ll need to sign up on the website for your state’s marketplace, if there’s one available.  If a state exchange isn’t available, you’ll need to register through the federal exchange (you can use the federal portal Healthcare.gov).  If you have selected your provider, you can also opt to sign up directly with the company.

If you have questions about enrollment, it’s advisable to contact a health insurance exchange navigator, who can walk you through the process and answer questions for you. You may also consider signing up by using an agent or a broker who will walk you through your different options and help you better navigate through what can sometimes be murky insurance jargon that is difficult to understand.

Qualifying for Special Enrollment

If you were unable to sign up during Open Enrollment because of issues with the call center or the exchange website, you can request a special enrollment period if you can prove this was indeed the case. Special enrollment periods are typically granted if Medicaid or CHIP denied your request for insurance as well. And exceptions can also be made for unusual circumstances that may have prevented you from signing up.  You’ll need to check on your state Health Insurance Exchange site for additional details.

Choosing Between State and Federal Exchanges

Under the ACA, states have the option of maintaining their own exchanges or having a state-federal partnership exchange. If there isn’t a state run exchange, you’ll buy your insurance through the Federally-Facilitated Marketplace (FFM). There are also hybrid states in which the federal government manages the individual marketplace and the state government operates the small-business (SHOP) exchange. How you purchase your healthcare insurance coverage will depend largely on how the state you’re residing in has decided to unroll ACA.  There is presently no uniformity, much like how state income taxes vary from state to state.

On top of this non-uniformity, there have been constant challenges to the affordable care act and future changes to the law are possible. As a result make sure to stay up to date on your mandated requirements. If you need help figuring out your health insurance, and whether a state exchange is available to you check out eHealth.

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