How to apply for Marketplace health insurance
If you’re looking to apply for Marketplace health insurance you’ve come to the right place. But before we get started, what is the Health Insurance Marketplace? The Marketplace is a service that allows you to search for, compare and buy an individual health insurance plan that meets the requirements laid out by the Affordable Care Act. Individual health insurance plans cover some, or all, of your healthcare costs. These can include going to the doctor, filling prescriptions, and planned and unplanned hospital visits.
Marketplace plans also have important consumer protections required by law. When you enroll in a Marketplace plan, sometimes known as Obamacare, your insurance company can’t charge you more or deny you coverage if you have a pre-existing condition. And your plan must include coverage for all “Essential Health Benefits”, including hospitalization, doctor visits, prescriptions and maternity care. You’ll also get access to free preventive care services, even before you’ve met your deductible.
Once you’re ready to apply for Marketplace health insurance, you have a few options. You can self-enroll online, have a Consumer Advocate help you over the phone, find local, in-person assistance, or complete and mail-in a paper application. In this article, we’re going to show you how to apply online through HealthSherpa, a certified enrollment partner of the government. If you’re unfamiliar with HealthSherpa, we offer all of the same plans at the same exact prices as HealthCare.gov, which is the government’s enrollment site. The main advantages of enrolling through HealthSherpa are a simpler enrollment process, a website that is easier to use, and the availability of a great Consumer Advocate team available via phone, email and chat, both before and after you’ve signed up.
During your enrollment journey, you might come across other companies that sell health insurance. However, some of them may offer plans that do not meet Affordable Care Act standards or have the built-in consumer protections we talked about above. Make sure to always read the fine print before you enroll. Every plan offered through HealthSherpa meets ACA standards, so you’re always safe when you enroll in coverage through us!
Now that we’ve covered the basics, let’s go over what you need to know when applying for Marketplace health insurance:
When can I enroll in a Marketplace plan?
Just about all Americans who don’t have insurance through their jobs can enroll in a Marketplace plan during the annual Open Enrollment Period. This runs between November 1st to December 15th in most states. A handful of states offer longer enrollment periods to allow people more time to sign up.
Special Enrollment Periods
You can also apply for Marketplace health insurance outside of Open Enrollment if you experience a qualifying life event. This will trigger a Special Enrollment Period that typically lasts 30 to 60 days. When you have one of these qualifying life events, it’s important to sign up as soon as possible so that you don’t miss your eligibility window.
Common qualifying life events include:
- Losing health insurance coverage (including through an employer, COBRA or Medicaid)
- Turning 26 and aging out of your parents’ health insurance
- Having a baby or adopting a child
- Getting married or divorced
- Moving to a new zip code (you must have had insurance prior to moving)
- Becoming a U.S. citizen
You’ll also want to note that losing coverage because you stopped paying your premiums does not qualify as a Special Enrollment Period. If this is the case, you’ll have to wait until Open Enrollment to enroll in a plan, unless you experience another qualifying life event.
What documents do I need to prove that I qualify for a Special Enrollment Period?
The type of documentation you need to prove that you qualify for an SEP depends on the type of qualifying life event that you experienced.
If you lost health insurance coverage, you may have to submit documents that show the day your coverage ended or will end. If you moved to a new zip code, you’ll have to both prove that you moved and that you had health insurance prior to your move. Or if you qualify for a Special Enrollment Period because you got married, had a baby, or became a citizen, you may have to submit government documents proving these events.
Need help uploading documents to the Marketplace? You can do that online here (account creation and identity verification are required by law). If you’d like to speak with someone who can help, you can reach our Consumer Advocate team at (855) 772-2663.
Am I eligible to enroll through the Marketplace?
In order to use the Marketplace, you must be a citizen, national or legal resident of the United States who currently resides in the US. This includes green card holders, refugees, asylees, and individuals with non-immigrant status who have a valid worker visa. (See here for a full list.)
There are two exceptions: you can’t use the Marketplace if you’re currently enrolled in Medicare or currently incarcerated. If you have health insurance through your employer, you can still apply for Marketplace health insurance but likely will pay full price. In general, we don’t recommend that people who have access to affordable health insurance through their employer enroll in Marketplace coverage.
How do I apply for Marketplace health insurance?
— If you’re looking for a step-by-step guide on how to enroll, you’re in luck. We created one that shows you how to enroll in 20 easy steps. Grab the free guide here. —
If you want to apply for Marketplace health insurance, the first step is to get a quote. It takes less than 5 minutes and no personally identifiable information is needed. You’ll enter your zip code and the age and gender of each person in your household who needs coverage, as well as your estimated annual household income. This information is required to determine if you qualify for government assistance.
Depending on your income, household size, and what state you live in, some or all members of your household may qualify for low- or no-cost health insurance through Medicaid or CHIP. Medicaid is a government-funded health insurance program for people with low incomes, but eligibility requirements differ from state to state. The Children’s Health Insurance Program, or CHIP, is Medicaid for Children, and has higher income limits. Often, some people in a household will qualify for Medicaid/CHIP and others will qualify for savings on a Marketplace plan.
If you don’t qualify for Medicaid but still make below certain income thresholds, you may qualify for savings on a Marketplace plan. There are two kinds of savings: Advance Premium Tax Credits and Cost Sharing Reductions.
- Advance Premium Tax Credits reduce the amount you pay in monthly premiums. The amount you receive in savings depends on your income, and they are applied automatically to your monthly bill.
- Cost Sharing Reductions mean you pay less for services when you use your insurance. For example, you may have lower copays when you visit your doctor, and a lower deductible to hit before your insurance starts sharing your medical bills. You can only use your cost-sharing reductions if you enroll in a Silver plan.
You’ll qualify for subsidies if your income is between 100% and 400% of the Federal Poverty Level. If your income is above $12,760 but below $51,040 (as an individual) or above $26,200 but below $104,800 (family of 4), typically you will qualify for savings on the Marketplace. The chart below can give you a sense of whether or not you and/or your family may be eligible for a subsidy based on your household income and size.
Here are the federal poverty levels for all states except Alaska and Hawaii:
|Number of people in family/household||100% FPL||138% FPL||400% FPL|
Easily find out how much of a subsidy you’ll qualify by entering your zip code below:
If you need help applying, call us at (872) 228-2549.
Once we’ve determined whether you qualify for savings, we’ll check if you qualify for a Special Enrollment Period. You’ll have to submit documents to prove your qualifying life event after you submit your application. Note that during Open Enrollment, you typically won’t need a qualifying life event or any supporting documentation to enroll. Although you may be asked for proof of income or immigration status after enrollment.
Choosing the best plan for you
HealthSherpa shows all plans from all insurance companies, and that can mean a lot of choices. You can always see a full list of plans available in your area, but we also provide a simple feature that helps you pick a plan based on your needs. This tool works by asking you a few quick questions:
- How much healthcare you expect to use throughout the year.
- If there are prescription drugs you need covered.
- And if you have any preferred doctors or hospitals.
This tool is completely unbiased and uses government data to recommend affordable plans based on the information that you provide.
Then we’ll show you the most affordable plan available in your area. You can also view and compare all additional plans, and sort by the lowest premium, metal tier, or your preferred insurance company, with comprehensive information about all of the plans and links to the insurers full plan documentation.
When choosing a plan, consider more than just what you’ll pay in premiums every month. How high your deductible and copayments are can have a big impact on your out-of-pocket costs for healthcare over the course of the year. In general, the more you pay in monthly premiums, the lower your deductible and copayments or coinsurance will be – and remember, you can only take advantage of Cost Sharing Reductions if you enroll in a Silver plan.
Filling out your health insurance application
Once you’ve picked your plan, it’s time to fill out the official application. Make sure you read the instructions for each question carefully. Filling out questions incorrectly or incompletely can lead to you getting an incorrect subsidy which can mean paying it back during tax season – or losing it entirely.
Because the savings you get on a Marketplace plan is technically a tax credit, the Marketplace application asks for information about your tax household. This includes the people in your family who appear on your tax return. Usually this will include your spouse and any children you claim as dependents on your taxes. You will have to fill out information about each person in your tax household, even if they are not applying for coverage.
Although you’re providing information about every member of your tax household, you do not have to provide immigration status unless you yourself are applying for coverage. If you don’t have a social security number, you also do not need to provide this on your Marketplace application. It’s important to know that information about immigration status collected by the Marketplace is carefully protected and cannot be used for immigration enforcement. More generally, by law the personal information that you provide on this form can only be used to determine your eligibility for coverage and to enroll you in a plan, and must be stored securely.
Once you complete the application, you’ll receive an official eligibility notice that says how much you qualify for in savings, and if anyone in your household qualifies for Medicaid. If the results aren’t what you expected, check out common mistakes below.
Common mistakes made with the Marketplace application
1. You are married, but indicated that you are filing separate tax returns.
If you’d like to receive subsidies on your Marketplace plan and are married, you must file a joint tax return. If you indicate on your application that you will file separately, your eligibility notice will show that you do not qualify for a subsidy.
2. You did not include all members of the tax household on the application.
You must include all members of your tax household on your Marketplace application, even if they aren’t applying for coverage. The amount of subsidy you are given is determined based on the total income of your tax household. So not including everyone on the Marketplace application can mean you’re given more savings than you are eligible for. If that happens, you’ll have to pay it back when you file your taxes.
3. You answered no, you would not like to find out if you qualify for help paying for coverage.
In order to receive a subsidy, you must answer “yes” to the question, “You may be able to get help paying for coverage, based on your estimated income. Do you want to see if you qualify?”
4. You did not fill out your qualifying life event details correctly.
If you are applying during a Special Enrollment Period, you must indicate what qualifying life event you have and what date it happened on. If you don’t, you will not be allowed to enroll. Note that this requirement only applies outside of Open Enrollment.
5. You filled out your income differently than you did in the screening questions.
The Marketplace application asks you to list all of your sources of income. When added up, this may be different than the income you estimated for yourself when you first received a quote on HealthSherpa. If so, you may receive more or less subsidy than we estimated for you.
6. You are eligible for COBRA continuation coverage and answered “yes” when asked if you were offered coverage through a job or someone else’s job.
COBRA is a program allowing you to continue the health coverage you had through an employer after you are no longer employed there. If you’re eligible for COBRA but decided not to enroll in it, this does not count as coverage offered through a job. If you answered “yes” to this question because you were offered COBRA, the Marketplace will incorrectly determine that you are not eligible for a subsidy.
What do I need to know after I sign up?
Once you’ve filled out the Marketplace application, there are a number of things you may have to do next before your coverage kicks in. You can complete all of these steps through your free HealthSherpa account.
Submitting required documentation
You may be asked to submit documents to prove your qualifying life event, your income, or your citizenship. If so, you’ll have 30 days to submit these documents through your HealthSherpa consumer account, your HealthCare.gov account, or by mail. If you applied for coverage through a state exchange (for example, Covered California or New York State of Health), you’ll have to submit documents directly to the exchange using the instructions they provided.
Paying monthly premium
Your health insurance coverage won’t begin until you’ve paid your first premium. You can pay your premium through your HealthSherpa account, by calling your health insurance company, or by calling our HealthSherpa payment line at (866) 796-6017. If you don’t pay your first premium by the due date, your coverage may be cancelled.
Did you know? Once you’ve paid your first premium, you’ll usually have a 90-day grace period on any future payments before your plan is cancelled.
Coverage start date
Your coverage can take a few weeks to begin; the exact time depends on when you enrolled. During Special Enrollment, if you apply before the 15th of the month, your coverage will usually begin on the first day of the next month. If you apply after the 15th, it will begin on the first day of the second month. In some cases, such as having a baby or adopting a child, the coverage may be retroactive to the day of the birth or adoption.
Reporting major life changes
Don’t forget to report any changes to your life circumstances throughout the year. You should report a change if any of the following occur:
- Someone in your tax household was offered other health insurance through an employer, even if they didn’t enroll
- You got married or divorced
- You had a baby or adopted a child
- Someone in your tax household became eligible for Medicaid/CHIP or Medicare
- Someone in your tax household lost eligibility for Medicaid/CHIP
- A child on your plan turned 26
- You became pregnant
- Your income changed
- Your citizenship or immigration status changed
- A member of your tax household passed away
- Your tax filing status changed
- Someone in your tax household lost coverage they were offered by an employer
- Your disability status changed
- Your status as an American Indian / Alaska Native or tribal member changed
These changes to your household circumstances can affect how much subsidy you qualify for. When you report a life change, your monthly premiums are automatically updated to account for this. However, if you don’t report a change, you may have to pay money back or be owed money when you file your taxes.
You can report any of these life changes through your HealthSherpa account, your HealthCare.gov account, or by calling our Consumer Advocate team at (855) 772-2663.
Health insurance and your taxes
When it comes time to file your federal income tax return, you’ll receive Form 1095-A in the mail. Your Form 1095-A will also be available in your HealthSherpa account and your HealthCare.gov account. You must use Form 1095-A to fill out your taxes if you received a subsidy.
Grab our guide to health insurance and your taxes to refer back to later.
Your HealthSherpa account
Once you’ve enrolled, you’ll get access to a free HealthSherpa account. You can also sign up for a HealthSherpa account if you’ve already applied for Marketplace coverage on HealthCare.gov or through another broker in the past. In your HealthSherpa account, you can access information about your coverage, find out how much your prescriptions cost, search for and choose a new doctor, report life changes to the Marketplace, download tax forms, and much more! Click here to create a FREE account.