Who Is the Marketplace for?
Each state plus Washington, D.C, now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone. The Marketplace, also called an Exchange, is mainly for people who:
- Don’t have insurance
- Aren’t insured by their employer
- Aren’t included in their spouse’s employer insurance
- Have pre-existing conditions and may have had trouble getting insurance before
- Have private insurance but want something less expensive
- Own a small business
The Affordable Care Act requires that most Americans have health insurance starting in 2014. Medicare is a different program. If you are on Medicare, you don’t need to buy insurance through the Marketplace.
When You Can Enroll: From Oct. 1, 2013, to Mar. 31, 2014. Coverage will begin in 2014. If you want your coverage to start Jan. 1, 2014, you have to sign up by Dec. 23, 2013.
If you have a life-changing event – birth of a child, losing your job – you don’t have to wait for the enrollment period. You can sign up or change coverage within 60 days of the event.
Plans and Costs
Types of plans: All the insurance plans on the Marketplace are sold by private companies or co-ops. They can offer four types of coverage: bronze, silver, gold and platinum. These “metal level” plans all cover the same kinds of benefits in the District of Columbia. What differs is how much they pay on average toward the costs of healthcare services. Here’s how it works:
- Bronze Plan: You pay 40% and the plan pays 60%.
- Silver Plan: You pay 30% and the plan pays 70%.
- Gold Plan: You pay 20% and the plan pays 80%.
- Platinum Plan: You pay 10% and the plan pays 90%.
Low cost – or catastrophic – plans are available, especially for people who are under 30 and are healthy. These plans cost less up front, but they don’t give you as much coverage. They generally require you to pay more out-of-pocket costs.
Costs: Companies on the Marketplace can vary costs based on your age, where you live in the state, and your tobacco use. They cannot charge you more because of your sex or your health condition.
A single 27-year-old could choose a silver-level plan (which pays about 70% of medical costs) that ranges from $178 a month to $238 a month. For a 40-year-old, silver-level plans range from $238 to $319 a month. The cost of a silver-level plan For a 55-year-old can range from $424 to $567 a month.
Who Can Sell Insurance in the Marketplace: Three companies are offering individual plans through DC Health Link. They are Aetna, CareFirst BlueCross BlueShield, and Kaiser Permanente.