The Patient Protection & Affordable Care Act (ACA) created a new way to find and buy private health insurance coverage for individuals and families: State Health Insurance Marketplaces. Originally called “exchanges,” the term “marketplace” refers to a place where you can find health insurance options from private insurance companies. These Marketplaces have been compared to an insurance shopping mall. The Marketplaces for most states are operated by the federal government at HealthCare.gov or 800-318-2596. Some states run their own Marketplaces. For example, if you live in California, you should access your Marketplace through CoveredCA.com. For other State-run Marketplaces, visit HealthCare.gov/marketplace-in-your-state.
There are real benefits to shopping for coverage through the Marketplace.
The amount of financial assistance that you may qualify for is based on your household size and income level. Your household can include the following people:
Your income level is measured by your modified adjusted gross income (MAGI). It can be helpful to have IRS form 1040 handy while calculating your MAGI:
These states that have expanded access to Medicaid under the ACA, providing coverage for people with household incomes up to 138% of the federal poverty level: AK, AR, AZ, CA, CO, CT, DC, DE, HI, IA, ID, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SD, UT, VA, VT, WA, WV.
If you live in a state with expanded Medicaid:
Note: the FPL numbers for the current year are used to determine Medicaid eligibility. The FPL numbers for the previous years are used to determine Marketplace financial assistance.
If you live in a state without expanded Medicaid (AL, FL, GA, KS, MS, NC, SC, TN, TX, WI, WY):
There is a new, monthly special enrollment period (SEP) for consumers with a household income under 150% of the FPL, to enroll in a Marketplace plan anytime during the year. States that run their own Marketplaces can choose to offer this SEP or not.
Although Medicaid applications are accepted all year round, there are two Marketplace enrollment periods: the Open Enrollment Period (OEP) and the Special Enrollment Period (SEP).
The 2023 Marketplace OEP is from November 1, 2022, through January 15, 2023. The earliest plans can begin is January 1. If you want your plan to begin on January 1, 2023, you must enroll by December 15, 2022. States that run their own Marketplaces may have different OEPs. Visit your state's marketplace for more information.
When you lose coverage or have a life-changing event, you may qualify for a SEP. You can enroll in a Marketplace plan through a 60-day SEP, for reasons that include:
Note: You may have other options if you lose employer-sponsored health insurance coverage. For details, watch our Animated Video on Options When You Lose Your Insurance at Work, or read our Quick Guide to Options When Losing Employer-Sponsored Health Insurance.
If you enroll during open enrollment, by December 15, in most states, your coverage will begin on January 1.
If you enroll during a special enrollment period, and enroll by the 15th of the month, coverage will be effective on the 1st of the following month.
However, if you enroll between the 16th and the last day of the month, coverage will be effective on the 1st of the second following month.
Changes in your income, household members, name or other identifying information, and status (disability, tax filing, citizenship/immigration, etc.) should be reported to the Marketplace. There are three ways to report these changes:
Triage Cancer offers a series of animated videos that describe key issues that people need to understand to effectively navigate cancer-related legal and practical issues, as well as manage the financial burden of a cancer diagnosis. These videos cover topics related to health insurance, employment, disability insurance, estate planning, clinical trials, cancer survivorship care plans, and more.
Watch the videos at: TriageCancer.org/AnimatedVideos
Triage Cancer Tools: Health Insurance Comparison Worksheet
Last updated: 1/2023
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