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Marketplace Health Insurance Coverage
Starting in 2014 a new set of health care service categories in place. These categories MUST be covered by insurers. It is based on the concept of Essential Health Benefits and the Affordable Care Act.
This act will ensure that the health insurance plans offered by companies to individuals and small groups (such as small businesses) will include a comprehensive package of services and other items. Different plans MAY offer additional services. This is where you compare and find the plan that is right for you and your family.
Please note, that insurance companies will still offer plans outside the HealthCaregov website. They are simply an aggregator of plans that insurance companies have opted to join.
A New Way to Lower Health Insurance Premium Costs
A new refundable or Advanced Premium Tax Credit (APTC) that lowers the cost of Qualified Health Plans
Eligibility is based on Household income, and family size (at end of year)
Income between 100% to 400% of the Federal Poverty Level (FPL) ($23,550 – $94,200 for a family of four in 2013)
Obtaining qualified health insurance through the Marketplace
Ineligibility for government-sponsored coverage, affordable employer-sponsored insurance, or certain other minimum essential coverage
The Premium Tax Credit is claimed on your income tax return
The bare minimum of services required under the essential health benefits are:
Patient Services – Ambulatory
Emergency Treatments
Hospitalization
Maternity Care
Newborn Care
Mental Health
Substance Abuse Disorders
Behavioral Treatment
Prescription Drugs
Rehabilitative Services
Lab Work
Preventive/Wellness Services
Chronic Diseases
Pediatric Services
ALL insurance policies are required to cover these benefits to be certified. Once certified, their policies will be able to be offered in the Health Insurance Marketplace. Note that all Medicaid state plans must cover these services by 2014.
Marketplace Health Insurance Coverage | HealthCare.gov Coverage | Healthcare.gob