Tips for Navigating the Health Insurance Marketplace

Federal health insurance reform led to the requirement that all U.S. residents have health insurance. Although that will no longer be the case after 2019, all residents are still required to have adequate health insurance in 2018. If you do not have health insurance, you may be fined when you file your annual income taxes. Health care reform also led to the creation of the online Health Insurance Marketplace to help residents search for appropriate health insurance plans. If you are currently in need of health insurance, then you should explore the Marketplace to choose a health care plan which will suit your needs. However, before you search for health insurance, you must learn how to use the Marketplace and maximize your health insurance benefits. Information you must familiarize yourself with includes when to enroll in a health insurance plan and the requirements for qualification. Below is a list of several tips for navigating the health insurance marketplace.

Accessing the Health Insurance Marketplace in Pennsylvania

When attempting to navigate the Health Insurance Marketplace for the first time, you must begin by locating the marketplace for your state. Currently, 15 states use their own online marketplaces. Like most states, however, Pennsylvania uses the federal Marketplace located at

Applying for New Health Insurance Coverage During Open Enrollment

Under typical circumstances, you will only be able to apply for health insurance coverage through the Marketplace during specified open enrollment periods. The exact dates of annual open enrollment vary each year, but they typically occur during the last two months of the year. Therefore, if you wish to switch from an insurance offered by your workplace or another plan to one in the Marketplace, you must wait until the next open enrollment period to do so.

Special Enrollment Periods

Although open enrollment is the typical time during which you can apply for coverage through the Health Insurance Marketplace, you may qualify for enrollment at other times of year based on status changes in your life. For example, if you lose your work-provided health care coverage due to losing your job, then you will immediately be able to sign up for new health insurance through the Marketplace. Similarly, any changes to your family status may qualify you for an immediate change of health care coverage. Examples of such status changes include having a child or getting married.

Health Insurance Renewal vs. Open Enrollment Periods

When navigating the health insurance marketplace, you must understand the difference between the open enrollment period and your health insurance renewal period. When you sign up for a health insurance plan, your coverage will last for one year. At the end of the year, your coverage may automatically renew, or you may have to manually renew it. However, you will not be able to change health insurance plans during your renewal period. Your health insurance plan may only be changed during open enrollment or if you have a major status change such as those listed above.

Health Insurance Marketplace Eligibility

You will only qualify for health insurance through the online Marketplace if you currently have no other health insurance plan. Also, you must meet other eligibility requirements. For instance, you must prove you are living in the United States legally. Additionally, you will not qualify for health insurance through the Marketplace if you are currently serving a prison sentence.

Covered Medical Conditions

You cannot be turned down for health insurance coverage through the online Marketplace based on your current physical health status as long as you meet the basic eligibility requirements. Health insurance obtained through the Marketplace covers pre-existing conditions. Your new health insurance plan will also cover preventative medical procedures, as well as essential care, such as annual checkups and certain hospital procedures. If you are pregnant, you can also obtain insurance coverage through the online Marketplace that will cover services related to your pregnancy.

Familiarizing Yourself With Your Insurance

One of the most important actions you must take when using the Health Insurance Marketplace is to familiarize yourself with the services offered under the plan you choose. You may be able to save a great deal of money by determining which services are cheapest under your health care plan. For example, some health care plans may give low rates for visits to a primary doctor but charge significantly more for certain procedures, while other plans may have higher copays for doctor visits but charge less for the same procedures. You must select a plan that offers the benefits you expect to need most often.

Re-Examine Health Insurance Options Before Open Enrollment

You must renew your health insurance during your annual renewal period. However, you will be allowed to change your coverage during open enrollment if you so choose. Health insurance benefits offered under your current health care plan are subject to change. Therefore, you may decide that your current health insurance plan no longer suits your needs. Also, new health care plans with new services are often added to the Health Insurance Marketplace. Examining new additions to your own plan, as well as to the Marketplace itself, will help you to make the best health insurance decision during the open enrollment period.