Monday, October 7, 2013

Hey, Doc: Who Can Enroll in 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 five in this series.

Q. Who can enroll?

A. The marketplace was designed for individuals who are buying their own insurance and who cannot get affordable coverage through their job or other sources. Small businesses also will be able to buy coverage for their employees through the marketplace. To be eligible to buy insurance in the marketplace, you must:

  • Live in the marketplace service area (generally a state);
  • Be a citizen or national of the United States or be lawfully present; and
  • Not be in jail.

If you are uninsured, the marketplace is an online place for you to shop for plans and to see if you are eligible for tax credits toward your monthly premiums or other costs. If you have coverage through your employer, your parents’ plan (up to age 26), or on your own but want to switch, you also can shop in the marketplace. Even if you are already sick with a preexisting condition, insurers cannot deny you coverage or charge you more because of your condition.
But not everyone will need to enroll. You may already be covered by a government insurance program like Medicare or Medicaid, or you might be happy with the plan you have, in which case you don’t have to buy anything new if you don’t want to.


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