Skip to content
My WebMD Sign In, Sign Up

The familiar world of health insurance is going through a lot of changes. If you're trying to get your bearings, take a look at what's different since the health reform bill became law.

The highlights:

  • Your children can't be denied coverage (and beginning in 2014, adults as well) because of health problems they had in the past. This is known as a "preexisting condition."
  • If you have children who are 19 to 26, they can stay on your insurance plan.
  • Insurance plans, with some exceptions, now cover some preventive medical services. You won't need to pay a co-payment or reach the deductible. These preventive services include certain vaccinations and screenings.

In the fall of 2013, health insurance Marketplaces were set up in each state. Marketplaces, also known as Exchanges, are websites where you can shop for coverage

What You'll Find in the Health Insurance Marketplace

What is it? The health insurance Marketplace is a new way to find health coverage. It lets you compare the costs and benefits of different plans.

Each state has a Marketplace. The federal government oversees the Marketplaces in some states. Other states run their own Marketplace.

The Marketplace offers different plans that vary by:

  • Types of services they provide
  • How much you have to pay for them

Plans can't turn you down because you have a health problem or you've had one in the past.

Who can use it? To get health insurance from an exchange, you must:

  • Be a U.S. citizen or legal immigrant
  • Not be in prison
  • Lack access to affordable coverage through an employer

Because of that, the Marketplaces are mostly be for people who are buying insurance on their own, as well as small businesses.

How does the Marketplace help me find a plan? Your Marketplace has tools and information to help you select between options, such as:

  • Websites for comparing available plans
  • Information in simple language about how each plan works
  • A toll-free phone number you can call for help
  • Calculator that shows you how much your options cost
  • Help with enrolling in government programs such as Medicaid if you're eligible

When does it start? The Marketplaces start providing health coverage in January 2014. Enrollment began in the fall of 2013.

Can I get help paying for coverage? Many people will be able to get tax credits to lower the cost of their coverage. You can get tax credits if you have a yearly income between:

  • $14,856 and $44,680 for a single person
  • $30,657 and $92,200 for a family of four

What if I don't want insurance? The law requires that you have it. If you don't have it through your job or a government program like Medicaid, you have to buy insurance. If you don't, you pay a penalty. The penalty starts in 2014 at:

  • $95 for each adult and $47.50 for each child, up to $285 per family
  • Or 1% of your family's income, whichever is higher

The penalty will rise in 2015 and again in 2016. However, you won't have to pay the fine for going without insurance if:

  • You have certain religious beliefs
  • Insurance would cost more than 8% of your income, even with help from an employer or the tax credits
  • Your income is so low that you aren't required to file a tax return ($10,000 for an individual; $20,000 for a family)