The Affordable Care Act (ACA) provides for all American Citizens to have access to health insurance underwritten by the US Government. Unless exempted, all American citizens and foreign residents must be covered by health insurance policies which must meet the Minimum Essential Coverage (MEC) as defined by the ACA.
To ensure that the American public has equal and affordable access, either as individuals, as employees or as special groups e.g. seniors or the disadvantaged, the Act established an open Marketplace for health insurance.
The market has three arms;
- The federally facilitated marketplace, (FFM) or more commonly Healthcare.com is the central exchange (information and purchase point) maintained by the Department of Health and Human Services, It is a secure online portal through which American citizens can shop for health insurance coverage.
Most States have their own ‘exchanges’ which may only offer health insurance coverage on terms that are equal to, or better than those available on the FFM.
FFM and State exchanges are defined as being ‘ON EXCHANGE’
- There are also Private Exchanges such as TrueCoverage who operate to the same standards but can offer insurances which take a broader view of individual and family needs. Private exchanges give advice based on considerations of personal circumstances and expert evaluations of the market. They are not agents for, or representatives of Health Insurance Companies.
- Finally, there are ‘off exchange’ private insurance companies who deal solely with their own products. The services covered by ‘off exchange’ insurers must meet MEC standards but the insurer may not offer premium tax credits or subsidies
Individuals and Small businesses can shop for health insurance plans, compare the benefits, get a free
quote and enroll through the FFM. The big advantage of shopping for health insurance via Federal, State or Private exchanges is the option to check whether you are eligible for a subsidy or premium tax credit.
The FFM also provides consumers, free customer support by trained ‘navigators’, who help to address all exchange related questions and navigation issues.
The shopping period is restricted to the Open Enrollment time every year unless you have a qualifying life event, such a change of employer or marriage for which you must apply for Special Enrollment or face a penalty for the time for which you are not covered.
The FFM plans must also offer the essential benefits laid down by the ACA such as preventive services, out-of-pocket maximums, no lifetime limits etc.
There are four steps involved in getting covered in the Federally Facilitated Marketplace:
- Create an account or get a free quote Login into healthcare.gov and provide your basic information to create an account. You can also get a free quote by directly applying for a plan.
- Apply for ACA PLANS available in your State. Fill in the form provided, by entering your/your family information such as income, household size etc. REMEBER these are the only factors which affect the premium for the plan you choose.
- Select a health insurance plan (s). Compare the plans available side-by-side, analyze their benefits and cost and check for subsidy eligibility.,
- Choose the plan that meets your budget and needs. Remember that you can seek the help of a navigator, via chat, email, or phone, anytime during this process. Enroll in a health insurance plan
Website: www.healthcare.gov Telephone number: 1-800-318-2596 TTY Number: 1-855-889-4325
28 States use the Federally Facilitated Marketplace FFM contact information:
- New Jersey
- North Carolina
- North Dakota
- South Carolina
- South Dakota