Hey, Doc: Does the Insurance Mandate Mean I Have to Buy Insurance Through the Marketplace?

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next several years. Texas physicians and the Texas Medical Association have carefully studied the law to help you understand what the changes mean to your health care. 

As the Affordable Care Act (ACA) continues to roll out, Me&My Doctor’s “Hey Doc” series will answer your frequently-asked questions, as well as some you might not have thought to ask.  

Check out part seven in this series.

Q. If I have insurance through my work or my spouse or my parents, do I have to give that up and buy insurance through the marketplace?

A. Not necessarily. Generally, if you already have health insurance, you satisfy the ACA’s requirement to have coverage. But there are a few things you may want to look into:

• Check with your employer to make sure it will continue providing coverage in 2014 and beyond.
• Check the status of your current plan to make sure it meets the new minimum requirements under the ACA. If you have your own insurance or a job-based plan that existed before the health reform law was enacted in 2010, it may be grandfathered in and nothing needs to change. Check with your insurance company or employer to find out.
• Children under the age of 26 can stay on their parents’ plan.
• f you already have coverage, you can still look at your options in the marketplace, but you may not qualify for financial assistance.

Q. Does the individual mandate mean I have to buy health insurance through the marketplace?

A. No. The individual mandate means you will have to have some form of health insurance, unless you qualify for an exemption. (See “Who must enroll? What if I don’t?”) But the marketplace is just one option for purchasing it on your own. Insurers do not have to participate in the marketplace, so you still can buy health plans the same way you do today, directly from health insurers, or through your employer if offered. You also can still get public insurance, if you qualify, directly from Medicaid, Medicare, or other government agencies.