Navigator
Resource Guide
On Private Health Insurance Coverage & The Health Insurance Marketplace
FAQs tagged with “Marketplace Coverage”
- Can family members in families with mixed immigration status, where some family members are lawfully present and others are undocumented, enroll in Medicaid or CHIP or receive help buying coverage through the Marketplaces?
- Can I buy or change private health plan coverage outside of open enrollment?
- Can I buy or change private health plan coverage outside of open enrollment?
- Can I pay my health insurance premium with a credit card, debit card, money order, or cash?
- Can my brother (or my church) pay my portion of the monthly health insurance premium for me?
- Does pregnancy trigger a special enrollment opportunity to buy or change coverage?
- Due to a natural disaster, I no longer have access to documents I need to verify my eligibility for a special enrollment period, and won’t make the Marketplace’s 30-day deadline to submit them. What should I do?
- How can I find out if a health plan covers the prescription drugs that I take?
- How can I find out if my doctor is in a health plan’s network?
- I am an American Indian. When can I enroll in a Marketplace plan?
- I buy my health plan directly from the insurance company. Why should I consider shopping for a new plan on the health insurance Marketplace?
- I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?
- I evacuated from my area because of a natural disaster, and none of my doctors are close by. What are my options?
- I filed my taxes but I still received a "Failure to Reconcile" notice from the IRS. What should I do?
- I got a notice that my Marketplace plan will be cancelled or terminated. What are my options?
- I have been diagnosed with a serious health condition and will be obtaining care from an out-of-state hospital. During my course of treatment I’ll be living near the hospital. Can I qualify for a special enrollment period based on this temporary “move”?
- I have Marketplace coverage and just had a baby. Can I change plans?
- I heard Marketplace plans have to cover certain health benefits referred to as essential. What are essential health benefits?
- I just got married and my spouse and I want to get Marketplace coverage. Do we qualify for a special enrollment period?
- I missed the deadline for submitting additional documentation to the Marketplace to prove my eligibility (to buy coverage or to qualify for premium tax credits or to receive an exemption). What can I do?
- I notice Marketplace plans are labeled “bronze,” “silver,” “gold,” and “platinum.” What does that mean?
- I pay more for my plan because I’m a smoker. If I stop smoking after I sign up, will my rates go down?
- I qualified for cost-sharing reduction subsidies when I signed up for coverage in the Marketplace. I’m getting more hours at work and might not qualify anymore. Will I have to change plans now and get a new deductible and out-of-pocket cap?
- I received a Form 1095-A called the “Health Insurance Marketplace Statement” in the mail. What is it and what do I do with it?
- I received a notice telling me it is open enrollment and time to renew my Marketplace plan. What do I need to do?
- I thought I was entitled to maternity coverage. Why isn’t it covered?
- I was denied coverage for a service my doctor said I need. How can I appeal the decision?
- I was in the hospital when my coverage changed from my old plan to my new, Marketplace plan. My provider during that episode of treatment is no longer in my plan’s network and I’m worried I’ll face higher cost-sharing as a result. Is this allowed?
- I’m 59, my wife is 55, and our kids are 24, 17, 15, and 13. What age premium will we be charged for health insurance in the Marketplace?
- I’m a college student and will be going to an out-of-state university. Can I qualify for a special enrollment period to sign up for a new plan in the state where I’ll be going to school?
- I’m a seasonal worker and spend 4 months of the year in a different state. Can I get a special enrollment opportunity to sign up for a new plan during the time I’m in that state?
- I’m buying coverage on the Marketplace for my family. I notice many health plans don’t cover pediatric dental care, but there are also stand-alone dental plans for sale. Is that allowed?
- I’m eligible for health benefits at work, but I want to see if I can get a better deal in the Marketplace. Can I do that?
- I’m losing my job-based coverage and have been given the option to sign up for COBRA. What are the pros and cons of doing that?
- I’m not going to be able to sign up for 2024 coverage during this year’s open enrollment because my home was damaged in a natural disaster. But I’m hoping I’ll be able to return to my home by early next year. Can I sign up for coverage then?
- I’m self-employed and the only employee I have is my spouse. What are my options?
- I’ve picked the plan I want. Now do I send my premium to the Marketplace?
- If I buy a plan during open enrollment, when does my coverage start?
- If I buy an individual health plan outside the health insurance Marketplace, is my coverage going to be the same as it would be inside the Marketplace?
- If I offer coverage, is there a minimum threshold for the number of employees that must enroll?
- My doctor says I need a prescription drug, but it’s not in my health plan’s formulary. I didn’t realize that when I enrolled in the plan. Shouldn’t my plan be required to cover a drug that my doctor says I need?
- My doctor’s office is located in a neighboring state. Will I still be able to see him if I get a plan on the marketplace?
- My husband and I are retired and spend 6 months of the year in Florida. Can we get a special enrollment opportunity to enroll in a new plan when we move to Florida, even though we’ll only be there for half the year?
- My income has gone down and I think I may now qualify for cost-sharing reduction subsidies in the health insurance Marketplace. Do I have to wait for an open enrollment period before I can enroll?
- My income has gone down and I think I may now qualify for premium tax credits in the health insurance Marketplace. Do I have to wait for an open enrollment period before I can enroll?
- My individual plan was retroactively cancelled even though I’ve been paying my premiums. I think it might be because I was recently diagnosed with a serious health condition. Is this allowed?
- My parents have Marketplace coverage, but don’t qualify for subsidies. I’m 24 and qualify on my own. My parents don’t claim me as a tax dependent. Can I be covered under their Marketplace policy and apply my premium tax credit to their premium?
- My plan sent me a notice that they didn’t meet the medical loss ratio (MLR) standard. Will I get a rebate?
- My spouse is an early retiree with affordable retiree health benefits from his former employer, but I’m not eligible to be on his plan. Can I apply for coverage and subsidies in the Marketplace?
- Should I use all of my advance premium tax credit (APTC) toward my monthly premium, or should I consider saving some of it to receive on my tax return next year?
- The Marketplace said I must submit additional information to document my eligibility (to buy coverage or to qualify for premium tax credits). They gave me 90 days. I won’t be able to gather the information that quickly. Can I request an extension?
- There’s only one Marketplace insurer in my area. What happens if that insurer leaves the Marketplace?
- What happens if I end up needing care from a doctor who isn’t in my plan’s network?
- What happens if I’m late with a monthly health insurance premium payment?
- What happens if my Marketplace insurer decides to discontinue its health plans on the Marketplace?
- What health plans are offered through the Marketplace?
- What if I sign up for a plan and change my mind? Can I switch my plan during open enrollment?
- What if there's a mistake on my Form 1095-A?
- What should I do if my plan doesn’t adopt policies allowing patients to obtain prescription drugs not on its formulary, and I have to pay the full price of the drug?
- When can I buy a health plan through the Marketplace?
- When should I return to the Marketplace to renew my plan and update my eligibility for subsidies?
- Who can buy coverage in the Marketplace?
- Why can’t I buy a plan when I need it? Why do I have to wait for the open enrollment period?
- Why should I buy a plan on the health insurance Marketplace?
- Will covered benefits under all Marketplace plans be the same? How can I compare?
- Will my Marketplace health plan cover dental benefits?