Health Insurance Marketplace

The Health Insurance Marketplace, a product of the Affordable Care Act, was created primarily for those who do not currently carry health insurance.

How the Marketplace Works

The Marketplace offers side-by-side comparisons of local plans based on price, benefits and other features. Plans are presented in four categories: bronze, silver, gold and platinum. The Marketplace application helps an individual determine whether he or she is eligible for lower coverage costs based on income and whether he or she qualifies for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program.

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 plans must cover treatments for those conditions. Many preventive services are covered at no cost to the individual.

Enrollment Period

Open enrollment for 2014 healthcare coverage is over. The next open enrollment period will be Nov. 15, 2014, through Jan. 15, 2015. Individuals and families with special cases, such as those who started the process before March 31, 2014, but ran into delays, may be able to sign up outside the open enrollment period. Special circumstances are listed at www.healthcare.gov.

How to Enroll

St. John Health System’s Marketplace assistance line, 918-744-2664 (option No. 1), connects individuals with a certified application counselor, who can answer questions and set up appointments for in-person enrollment. Working with a CAC to enroll in a plan helps minimize confusion about Marketplace options and ensures desired providers and benefits are included in the selected plan. Individuals may also enroll online at www.healthcare.gov.

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 a petition exception based on “network confusion.” These petitions are complex and handled on a case-by-case basis. General information about the Marketplace and St. John can be provided via the St. John PulseLine at 918-744-0123.

Search for a Physician

Learn more about St. John primary care physicians with our Find a Physician search.