Health Insurance Marketplace

THE HEALTH INSURANCE MARKETPLACE, A PRODUCT OF THE AFFORDABLE CARE ACT, ALLOWS INDIVIDUALS AND FAMILIES TO FIND COVERAGE THAT BEST FITS THEIR BUDGET AND NEEDS.

The Health Insurance Marketplace offers side-by-side comparisons of local plans based on price, benefits and other features. The Marketplace helps determine who is eligible for low-cost coverage based on income and family size, as well as who qualifies for free or low-cost coverage through Medicaid (SoonerCare). Most U.S. citizens and legal residents are now required by law (Affordable Care Act, 2010) to have qualifying health insurance or pay a tax penalty.

Health insurance plans in the Marketplace are offered by private companies, including CommunityCare, with the same core set of benefits, called "essential health benefits." No plan can turn an individual away or charge more because of a pre-existing illness or medical condition, and many preventive services are covered at no cost to the individual.

Important Dates

Enrollment is closed for health insurance coverage through the Marketplace for 2015. The 2016 open enrollment period is tentatively set for Oct. 1 through Dec. 15, 2015. Marketplace coverage for 2015 will end Dec. 31 and for 2016 can begin as early as Jan. 1. During the next open enrollment period, those who previously enrolled will need to update their information and re-enroll in a plan for 2016. Plans and benefits offered in the Marketplace change from one year to the next, making it essential to carefully review plans prior to re-enrolling in a plan or selecting a new plan.

Individuals and families with special cases, such as those with a qualifying life event, may be able to sign up outside the open enrollment periods. Special circumstances are listed at www.healthcare.gov (www.cuidadodesalud.gov).

How to Enroll

During open enrollment, there are several ways you can apply for coverage through the Marketplace:

  • Apply with a private insurance carrier like CommunityCare.
  • Apply with one-on-one assistance from a certified application counselor (CAC) or navigator (see below).
  • Apply on your own via www.healthcare.gov (www.cuidadodesalud.gov) or 1-800-318-2596.
  • Apply with an insurance broker.

During open enrollment, St. John Health System's Marketplace assistance line connects individuals with one of our CACs, who can answer questions and set up appointments for on-site enrollment. CACs help minimize confusion about Marketplace options and ensure desired providers and benefits are included in the selected plan. More information will be listed on this site closer to the open enrollment period.

Those who want to change plans in which they are enrolled may call the HealthCare.gov customer service desk at 1-800-318-2596 and request an exception based on "network confusion." These petitions are complex and handled on a case-by-case basis.

General Information

More information about the Marketplace and St. John is available via the St. John PulseLine, 918-744-0123 or pulseline@sjmc.org.