Health Insurance Marketplace

Health Insurance Marketplace Health Insurance Marketplace

 Health Insurance Marketplace

It is a service that helps people shop for, and enroll in affordable health insurance. The federal government operates the Marketplace, available at, for most states. Some states run their own Marketplaces.

It is also a type of Organizations that facilitate structured and competitive markets for purchasing health coverage. The Health Insurance Marketplace, or “Exchange,” offers standardized health insurance plans to individuals, families and small businesses. Certain states operate their own marketplace, while others opt for a partnership exchange where the federal government manages the marketplace. In each state, various private insurance companies submit plans to be included in the marketplace. The marketplace plans are separated into four primary levels: Bronze, Silver, Gold and Platinum, each based on the average percentage the plan pays toward health-care services.

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BREAKING DOWN  Health Insurance Marketplace

The Health Insurance Marketplace was established as part of the Patient Protection and Affordable Care Act (ACA), the U.S. health reform signed into law by President Barack Obama on March 23, 2010. The marketplaces are intended to provide places where consumers can compare and purchase standardized health coverage that includes a mandatory set of covered health-care items and services known as essential health benefits. These benefits are minimum requirements for all health plans offered to individuals or through the small-group market to employers with 50 or fewer employees. They include ambulatory patient services, emergency services, hospitalization, laboratory services, maternity/newborn care, mental health services and addiction treatment, rehabilitative services and devices, pediatric services, prescription drugs, preventive and wellness services, and chronic disease management.


Most individuals and families qualify for federal subsidies that can help lower health insurance costs. Cost-sharing reductions can help lower out-of-pocket costs such as deductibles, copayments, and coinsurance, and advanced premium tax credits can reduce the amount consumers pay each month for their health insurance premiums. Both subsidies are available only to qualified individuals who meet certain income requirements and who are ineligible for public coverage (such as Medicaid and the Children’s Health Insurance Plan), are unable to get qualified health insurance through an employer, and who purchase health coverage on the Health Insurance Marketplace.

Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly. It is often included in employer benefit packages as a means of enticing quality employees. The cost of health insurance premiums is deductible to the payer, and benefits received are tax-free.

The Health Insurance Marketplace (also known as the “Marketplace” or “exchange”) provides health plan shopping and enrollment services through websites, call centers, and in-person help.

Small businesses can use the Small Business Health Options Program (SHOP) Marketplace to provide health insurance for their employees.

When an individual applies for individual and family coverage through the Marketplace, he/she will provide income and household information. He/she will find out if he/she qualifies for:

Premium tax credits and other savings that make insurance more affordable

Coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state.

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Provisions of the Patient Protection and Affordable Care Act

Insurers are prohibited from discriminating against or charging higher rates for any individual based on pre-existing medical conditions or gender.  Insurers are prohibited from establishing annual spending caps of dollar amounts on essential health benefits.

All private health insurance plans offered in the Marketplace must offer the following essential health benefits: ambulatory care, emergency services , hospitalization (such as surgery), maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services (services to help people with injuries, disabilities, or chronic conditions to recover), laboratory services, preventive and wellness services, and pediatric services.

People can purchase health insurance that complies with the Patient Protection and Affordable Care Act (ACA, known colloquially as “Obamacare”) at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.

Private non-ACA health care exchanges also exist in many states, responsible for enrolling 3 million people. These exchanges predate the Affordable Care Act and facilitate insurance plans for employees of small and medium-size businesses.

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In the United States, health insurance marketplaces also called health exchanges, are organizations in each state through which people can purchase health insurance, it provides health plan shopping and enrollment services through websites, call centers, and in-person help.