3 of the Biggest Marketplace Health Insurance Questions This Year

This year, for many, has certainly come with its share of difficult challenges. Americans can, however, look forward to the joys of the holiday season ahead. But in addition to those Halloween costumes and Thanksgiving turkey, there is another important date fast approaching – Open Enrollment.

The Marketplace will be open for individuals and families to browse and select new health insurance plans for next year. Beginning November 1st and ending December 15th, you will need to find and enroll for coverage. If you’re like most Americans, you likely have health insurance questions. And you’re in good hands because today, we’ll review three of the biggest Marketplace-related questions this year. There are the insights you might just be needing to help you prepare for Open Enrollment.

How Does My Income Affect My Health Insurance Options?

Whether you continued to work through shuttered economies this year or found yourself furloughed from a job, you might have experienced inconsistencies with your income. Your income levels do matter when choosing a health insurance plan, especially when it comes to leveraging potential benefits. These health insurance questions might be at the top of your list, and we’re here to offer those much-needed answers.

What Are the Income Limits for Marketplace Health Insurance?
Based on your estimated income, you may qualify for tax credits that can significantly reduce your health insurance premiums. The income guidelines are based on your household income and how it compares to federal poverty levels. Single individuals with an annual income for 2020 between $12,490 and $49,960, for example, would qualify. Families of three should report between $21,330 and $85,320 to be eligible. In all, your household income must fall within 100% and 400% of the federal poverty line to benefit from the premium tax credit. And if your state offers an expanded Medicaid platform, the income benchmarks are required to fall below 138% to qualify.

What If I Accidentally Underestimate My Income this Year?
Because you’re attempting to estimate your income and projecting what your income might be going into next year, there is room for error. So, what happens if you underestimate your income during Open Enrollment and end up earning more than you projected? If you receive tax credits that you no longer become eligible for due to an underestimate of income, you will have to pay those amounts back. So, it’s critical to do your best to project now and contact the Marketplace should you anticipate earning more down the road.

What If I Accidentally Overestimate My Income this Year?
Projecting incorrect income levels works both ways. You might anticipate making a certain amount of money, only later to experience a reduction in pay or job instability that lowers your household totals. If you experience a financial setback and end up qualifying for more of a tax credit than you originally qualified for, you should contact the Marketplace. Any subsidies owed to you will be given as part of your tax refund when you file your taxes at the end of the year.

What If I Have Pre-Existing Health Conditions?

Another concern and common health insurance question involves pre-existing health conditions. You or even a member of your immediate household could be managing diabetes, have a chronic illness, or fall into a high-risk health category. You may be wondering if any of these scenarios will affect which health insurance plans become available to you.

What Does the Marketplace Consider a Pre-Existing Condition?
Any health problem or ongoing concern that was diagnosed before the start date of your new insurance plan is a pre-existing condition. Some examples of more common problems include asthma, cancer, and diabetes. This not only applies to coverage for you but also includes any family members you’re looking to cover under the new insurance plan.

Do Marketplace Plans Cover Pre-Existing Conditions?
Every insurance company, with coverage options available in the Marketplace, must cover pre-existing conditions. Any treatments, testing, and doctors’ visits associated with the treatment or management of a condition will be covered. You can rest assured knowing that no health insurance plan can charge you more, reject your or your members, or refuse to pay for services required to address any conditions you had prior to coverage starting.

Are There Any Conditions That Aren’t Covered by Marketplace Health Insurance?
While more common diagnoses’ might be listed specifically as pre-existing conditions that require coverage, you might wonder if there are any outlying anomalies that won’t be covered. There are some conditions that are rare or require unique medical treatments beyond some of the more common afflictions. And you may also be wondering if a COVID-19 diagnosis, that may present more long-term health effects, falls into this category. No official statements have been made disqualifying COVID-19 diagnoses from required health insurance coverage, and there is still much health officials don’t know about the residual effects of having the virus. As it stands today, health insurers can’t refuse coverage, charge more, or deny payments based on any condition you had prior to your plan enrollment date.

Where Do I Begin My Marketplace Insurance Enrollment Process?

If navigating the Marketplace to shop for health insurance plans is new to you, you probably have questions. And other common health insurance questions involve the upcoming Open Enrollment period window. It can be a challenge, and even intimidating to some, to know where to get started.

Can I Enroll Whenever I’m Ready?
Americans can only enroll for Marketplace health insurance plans during the Open Enrollment period designated each year. This year, you’ll only be able to register during November 1st and December 15th. Any plan you select will go into effect on January 1st of next year. If you fail to enroll during this upcoming period, you will not be able to purchase health insurance coverage for 2021 unless you qualify for a Special Enrollment Period or Qualifying Event.

What If I Miss the Open Enrollment Period?
If you do not have health insurance, you need to select a Marketplace plan during this upcoming Open Enrollment. Not enrolling could translate to no having health insurance for the 2021 coverage year. Only those individuals and families who experience a Qualifying Event will be eligible to enroll outside the designated Open Enrollment period. Should you lose your job or employer-sponsored healthcare coverage, for example, you would then be allocated a window of time to purchase Marketplace insurance. Other circumstances that would allow enrollment after Open Enrollment closes include getting married or having a baby.

Where Do I Enroll for a Health Insurance Plan?
When you’re ready to begin your quest for a health insurance plan, you can browse and explore the options on the Marketplace platform directly. But it can be confusing for some, and you may have questions about how to determine your benefits. Each provider will outline plan details, including premium payments, deductibles, and in-network provider considerations. If you need help sorting through or have health insurance questions, you can instead get free and expert guidance from W3LL. Browse the same Marketplace plans with us. Answering a few quick questions is all it takes to get started, and you’ll have someone available to help you determine which plan is best for you.

Don’t let this Open Enrollment period pass before you’re able to select a health insurance plan. And when you’re ready, browse with W3LL. We can offer insights at every stage of your process and ensure all of your health insurance questions this year get answered.

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