Marketplace Review and Update

Amira Wazir

By Amira Wazeer

Recently at a Messer Financial seminar I was told that 60 percent of Americans did not know that it was a law that you had to purchase healthcare. I asked myself how that could be; the news has been saturated with the fight to make it happen for years.

I spoke at a meeting of the Halal business Network here in Atlanta later on that day. I asked the Muslim audience to raise their hands if they did not know that healthcare purchase was a law.

No one raised their hands. So from that I made the assumption we are more knowledgeable about healthcare than most Americans.

However, I still get asked some of the same questions so I know I just need to repeat a few facts for those of us who need to hear them and update a few for everyone. Here’s a quick rundown on the most important things to know about the Affordable healthcare plans commonly known as Obamacare.

You sign up for the plans at the Health Insurance Marketplace, sometimes known as the health insurance “exchange.”  The web address is or if you know an agent in your area then it is best to sign up with an agent. An agent can counsel you and possibly save you money, time and aggravation.

Time lines are crucial in dealing with the marketplace. Health care plans are available for preview on November 7th and will be available to purchase on Nov 15th. You can purchase healthcare up until February 14 then you will be locked in until the following enrollment season in November 2015.

Important: Before November 15, 2014, you can enroll in a Marketplace health plan only if you qualify for a Special Enrollment Period. Any plan you enroll in before November 15, 2014 ends Dec. 31, 2014.

Use the Marketplace to get covered:

The Health Insurance Marketplace helps uninsured people enroll in health coverage. Fill out a Marketplace application and the calculator will tell you if you qualify for:

Private health insurance with savings based on your income. Plans cover essential health benefits, pre-existing conditions, and preventive care. Most people who apply through the Marketplace qualify for premium tax credits and savings on out-of-pocket costs based on household size and income.
Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide free or low-cost coverage to millions of families with limited income. Many states are expanding Medicaid to cover more people.
If you live in a state that refused the Medicaid expansion things may change next year. I believe eventually all of the states will accept it; it is just a matter of time.
Fees, exemptions and qualifying coverage:

Most people must have health coverage or pay a fee. If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child) — whichever is higher.
You’re considered covered under the health care law if you have any job-based plan, any plan you bought yourself, Medicare, Medicaid, CHIP, and many other kinds of coverage. See a full list of plans and programs that meet the health law’s coverage requirement.
Some people qualify for an exemption from the fee based on income or other situations.
When you buy health insurance coverage in the Marketplace, you may be able to get a premium tax credit that lowers what you pay in monthly premiums. This will depend on your 2015 household size and income.
You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less for your premiums each month. This is called “advance payment of the premium tax credit.”
Savings depend on 2015 income and family size:

If your 2015 income falls within the following ranges you'll generally qualify for a premium tax credit. The lower your income is within these ranges, the bigger your credit.

$11,670 to $46,680 for individuals
$15,730 to $62,920 for a family of 2
$19,790 to $79,160 for a family of 3
$23,850 to $95,400 for a family of 4
$27,910 to $111,640 for a family of 5
$31,970 to $127,880 for a family of 6
$36,030 to $144,120 for a family of 7
$40,090 to $160,360 for a family of 8
If your income falls between the amounts shown, you also qualify for premium tax credits that lower your monthly premiums.

Out-of-pocket savings apply only to Silver plans
Plans in the Marketplace are grouped into 4 categories: Bronze, Silver, Gold, and Platinum.
If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. You can choose any category of plan, but you'll get the out-of-pocket savings only if you enroll in a Silver plan.
Savings at lower income levels:

If your 2015 income falls below the amounts shown on the chart, you may qualify for coverage under your state’s Medicaid program. This is true if you live in a state that’s decided to expand Medicaid to cover more people.

But if ALL of the following apply, you can’t get premium tax credits when you buy a private insurance plan through the Marketplace:

Your income falls below the amounts shown on the chart
Your state is not expanding Medicaid
You don't qualify for Medicaid under your state's rules
5 more things to know:

If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you’ll qualify for premium tax credits and other savings based on your income only if the job-based insurance isn't considered affordable or doesn’t meet minimum value requirements.
Unaffordable means the premiums cost you more than 9.5 percent of your gross income. There is a form located on you can take to your HR department to fill out and you can submit for a determination.
If you have Medicare, you’re considered covered and don’t have to make any changes. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan.
You can buy a plan outside the Marketplace and still meet the health care law’s coverage requirements. But if you buy outside the Marketplace, you won’t be eligible for premium tax credits or other savings based on your income.
If your income is too high to qualify for a tax subsidy I recommend you look off exchange plans for sure. The off exchange plans may offer better plans than what is available on
Open Enrollment starts November 15, 2014. You can’t apply for 2015 coverage until then. In the meantime, you can get ready to apply.
(Amira Wazeer is a state licensed and federally certified insurance agent with over 14 years experience.  She specializes in Medicare plans, Affordable healthcare plans, dental and vision plans, Life insurance for diabetics and Janazza (final expense) insurance. Consultations are free. Need a speaker at your upcoming events or have Questions and comments contact or call 404-202-1926.)


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