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What is a Health Insurance Marketplace?

If you are looking for affordable health insurance coverage and better plan options, then you have come to the right place. In this article, I’ll cover everything you need to know about health insurance marketplace. You’ll find out what is the purpose of Health Insurance Marketplace plan selection, eligibility, enrollment process and much more.

What is a Health Insurance Marketplace?

The purpose of health insurance marketplaces, commonly referred to as exchanges, is to develop more competitive and organized health insurance markets. 

They provide a variety of health plans for consumers to choose from, certify the plans that participate, and offer information and in-person assistance to help customers understand their options and apply for coverage. If they need to purchase their own health insurance, people and families can shop for coverage through the Marketplace. 

Through the Marketplace, income-based premium and cost-sharing subsidies are offered to help individuals and families purchase insurance. If they qualify for Medicaid and CHIP coverage, those with extremely low incomes can also check this information at the Marketplace.

Finally, through the Small Business Health Options Program (SHOP) Marketplace plans, small firms can purchase insurance for their staff members.

Every state has a health insurance Marketplace for people, families, and small companies. Some have a unique state name and are run by the State (such as Covered California or The Maryland Health Benefit Exchange.) is the name of the Marketplace in other states where it is managed by the federal government.

Eligibility to buy coverage in the Marketplace

The Marketplace allows most people to buy coverage. You should be a citizen of the United States or be legally present in the country, and reside in the state where your Marketplace is located also You must not currently be imprisoned in order to qualify.

However, not everyone who qualifies for subsidies will also be qualified to purchase insurance through the Marketplace. Subsidies, sometimes known as premium tax credits, have extra criteria that customers must meet about their income and other coverage eligibility.

Plans Available in Health Insurance Marketplace

All private health insurance plans available in the Health Insurance Marketplace provide coverage for ten different service categories, which are referred to as essential health benefits. Categories are listed below:

  • Ambulatory patient care (outpatient care you get without being admitted to a hospital).
  • Services for emergencies.
  • Hospitalization (like surgery and overnight stays) (like surgery and overnight stays).
  • Pregnancy and infant care (both before and after birth).
  • Services for mental health and substance abuse disorders, such as behavioural health treatment, counselling, and psychotherapy.
  • Prescription medications
  • Rehabilitation services and equipment.
  • Services for laboratories.
  • Prevention and wellness services, as well as chronic disease management.
  • Pediatric services, including oral and vision care (adult dental and vision coverage is not included).

Is green card mandatory to buy a plan on the marketplace?

You cannot buy a plan through the health insurance Marketplace if you are not a U.S. citizen, U.S. national, or a person with a valid visa for entry into the country. However, you can shop for health insurance in the non-group market outside of the Marketplace. 

Outside the Marketplace, insurers are not allowed to deny you coverage based on your health or immigration status and are required to abide by the same regulations as Marketplace plans. 

Contact a health insurance provider with a state license, or a registered agent or broker, to enroll in coverage. You can locate one with the aid of your state’s insurance department.

Who can help with my Marketplace application?

To assist customers in completing their applications for financial help, including assistance with applying for Medicaid or CHIP, all state marketplaces are mandated to offer Navigator programmes. 

Additionally, navigators assist clients with plan reviews and Marketplace appeals. In addition to completing Marketplace training and abstaining from conflicts of interest, navigators are compensated by the Marketplace, not by health plans.

Additionally, you might be able to get on-site assistance from other sources. In addition to Navigators, hospitals, community health centres, and other nonprofit organizations also conduct various volunteer assister programmes that are approved by the Marketplace. Although they get no support from the Marketplace, some certified assistant programmes do complete Marketplace training.

To apply for private health insurance policies through the Marketplace, some individuals deal with private insurance brokers. Additionally, brokers must take marketplace training. 

Each policy they sell earns them commission from the health insurance companies. On the website for your state’s marketplace, you can find a list of certified Navigators, assistants, and brokers.

How do I Enrol for Health Insurance Marketplace?

You can only enroll for a Marketplace plan during the Open Enrollment Period. Medicaid and CHIP enrollment are both open-ended.

You can submit an application for a Marketplace plan during the Open Enrollment Period through phone, online, on paper, or with the assistance of a professional assister in your neighbourhood. The How to Apply & Enroll page has more information on applying.

Some individuals might be eligible for Special Enrollment Periods, which give them the opportunity to enroll in a Marketplace plan outside of Open Enrollment if certain life events occur, such as getting married, having a child, or losing existing coverage.

Steps After you enrol:

  • Your new insurance card and further details about your health plan will be included in a packet you get in the mail. Start utilising your coverage.
  • If you need to modify your plan because of a move, a pregnancy, or an adoption, you can do so.
  • As quickly as possible, revise your application if your household or economic situation changes. Savings and coverage options may be impacted.
  • If you qualify for Medicaid or CHIP, your state will contact you regarding enrollment and the further steps.


One of the common principles in the healthcare industry is that consumers have the right to make smart, informed decisions about their personal health. Consumers should have access to quality information on medical treatments, hospitals, and insurance plans.

We really hope this article has helped you about Health Insurance Marketplace. In you still have any query we would love to answer it in the comment section.


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