3 Requirements You Should Expect from Your Marketplace Health Insurance Plan

3 Requirements You Should Expect from Your Marketplace Health Insurance Plan

Open Enrollment is happening now, and as you consider your options for health insurance coverage in 2021, you might be curious about expectations. You still have some time to decide, and the enrollment period will go through December 15th. But you’ll want to get started in your research if you haven’t already.

There are plenty of government guides and resources out there outlining what the insurance companies expect from you, including qualifications, premium payments, etc. But what is required of the insurance providers? And what should you expect from them with the plan you select. We’ll highlight three requirements and non-negotiable expectations you can predict from your Marketplace health insurance plan.

Health Insurance Options Are Available without Discrimination

One thing you don’t have to worry about when selecting a health insurance plan from the Marketplace is discrimination. Regardless of your personal details, health benchmarks, or family tree, you will be able to browse affordable health care plans that are ready to enroll you for 2021.

Pre-Existing Conditions
The Marketplace health insurance plans cannot deny coverage nor charge more for coverage based on your current health. Any pre-existing conditions or even treatments you may have received in the past cannot count against you when it comes time to enroll in a new plan. Pre-existing conditions may include conditions like diabetes, high blood pressure, or depression.

Your Age & Gender
By law, health insurance providers offering plans via the Marketplace cannot charge differently or deny coverage based on age or gender. This can be reassuring to older Americans who may be worried about health concerns in the future. It is also helpful for men and women of any age to know that gender-specific health issues or preventative measures won’t affect what insurance plans are available, nor how much they cost.

Family History
Some individuals may fall into higher risk health categories based on genetics and family history alone. If you have reservations about your health risks based on conditions that are prevalent in your family tree, rest assured, your options for healthcare won’t change. Marketplace providers cannot discriminate against anyone for their potential risks based on predisposition or a family history of conditions.

Guaranteed to Have Options

Another requirement of the Marketplace and its participating health insurance providers is to present valuable options for everyone. You can expect to have a choice between various plans and not be forced into selecting a coverage option you don’t want.

Guaranteed Renewal
If you’ve already enrolled in a health insurance plan through the Marketplace for this year and are satisfied with the coverage, you are guaranteed the opportunity to renew the same plan. Your current carrier is required to authorize a renewal, regardless of your past claims, as long as you maintain your premium payments. Some states do allow for variances in charges, so be sure to verify the costs for 2021 and re-read any changes to policies for deductibles, in-network providers, or out-of-pocket maximums.

You’re Free to Change Providers
Rest assured that if you’ve had a provider for 2020 that didn’t quite fit your needs, you are guaranteed the right to change carriers and find a new plan. Any claims or benefits you may have leveraged with your current provider will have no bearing on the availability of new plans.

Your Needs Change, So Should Your Health Insurance
When you selected a health insurance plan last year, you maybe felt your decision was based more on premium costs and your budget. But this year, as an example, you might have a baby on the way or anticipate getting married. These are life-changing events that warrant a different approach to choosing health insurance. The Marketplace is required to provide you options now, during the Open Enrollment period. But it will also provide you with a Special Enrollment Period based on future qualifying life events.

Healthcare Protections & Reassurances

There are certain aspects of healthcare and health insurance that the current health care laws protect. These are things the Marketplace insurance providers are required to offer or maintain. And it’s just one less question you have to worry about asking when choosing a new health insurance plan.

Preventative Care
Preventative care services for most health plans are free. So you can expect most plans to offer some form of preventative care, for adults, women, or children, at no charge to you. These include routine doctor visits, screening tests, and in some cases, vaccines. Be mindful of the terms of the plan you’re reviewing. There are often stipulations about your providers being in-network to qualify for free preventative care.

Employer Retaliation
You will be afforded certain protections, as an individual, under the law to protect you from retaliation at work. Employers can’t fire staff or engage in discriminatory behavior towards employees who opted for health insurance through the Marketplace or qualified for a premium tax credit. You are also protected should you report any violations of the reforms listed in Title I of the Affordable Care Act.

Understanding the Coverage
The Marketplace ensures that health insurance providers provide clear and concise language about their terms of coverage, costs, and provider networks. When you’re ready to browse, you should be able to search and review plan details. And because health insurance shopping can be tedious, you might need a little help. The experts at W3ll are available to help you calculate your benefits, search for qualifying plans that match your preferences, and ultimately enroll in the best program for you. And you can be guaranteed that our guidance throughout the entire process is free.

The requirements for Marketplace insurance are outlined clearly and include residence in the United States and citizenship. But there are certain protections you can require of your chosen Marketplace insurance plan, as well. And these guidelines are designed to ensure you have ample opportunity to select your preferred affordable health care.

W3ll is here to help you recognize these protections and any additional benefits for which you might qualify. You have an ally during the Open Enrollment period. Begin browsing with us today.

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