Marketplace / HealthCare.gov

The Health Insurance “Marketplace” refers to a website (HealthCare.gov) where people can purchase health insurance.

Who is eligible for Marketplace / HealthCare.gov insurance?

If you don’t have coverage through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP or MIChild), or another source, the Marketplace helps you find and enroll in a plan that fits your budget and meets your needs. You must be a U.S. Citizen or have eligible immigration status, which means:

• People who hold Permanent Resident Green Cards and have been in the U.S. for less than 5 years
• People with Employment Authorization Documents or work permits

People who cannot afford their employer insurance can also enroll through the Marketplace.

What services does Marketplace / HealthCare.gov

insurance cover?

All plans offered in the Marketplace cover these essential health benefits:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
• Birth control coverage
• Breastfeeding coverage

Plans must offer dental coverage for children. Dental benefits for adults are optional.

How do I get Marketplace / HealthCare.gov insurance?

Apply for Marketplace coverage by creating an account at HealthCare.gov and completing an application. After your application is submitted, you receive an eligibility notice with your tax credit, eligibility for Special Enrollment, and next steps.

Enroll by using the tools available to compare plans, then selecting one.

You must pay your first payment—called the binder payment—within 30 days of your start date. If you have new insurance and need to see new providers, make an appointment with your new primary care physician as soon as possible.

Washtenaw Health Project’s enrollment staff are all Health Insurance Marketplace Certified Application Counselors or Navigators and can help you at any stage of this process. Make an appointment by calling 734-544-3030 or emailing us at whp@washtenaw.org.

When can I enroll in Marketplace / HealthCare.gov insurance?

You can enroll in Marketplace/HealthCare.gov during the Open Enrollment period, which is from November 1 to January 15. If you want your insurance to start on January 1, it is best to enroll by December 15.

If Open Enrollment is closed, you may qualify for a Special Enrollment Period. Special Enrollment Periods include birth, adoption, death, marriage, loss of employment insurance, moving from one county or state to another and divorce.

If you lose or are denied Medicaid or MIChild (CHIP) in 2023-2024:

If you lose or are denied Medicaid or MIChild (CHIP) coverage after March 31, 2023, you can enroll in Marketplace/HealthCare.gov coverage at any time between March 31, 2023 and July 31, 2024. You can start your application to 60 days before you expect to lose Medicaid coverage so that you don’t have a gap in coverage. Your coverage will go into effect at the beginning of the month after your application is completed. Additionally, you qualify for a Special Enrollment Period with your employer sponsored insurance. Your employer is legally required to give you 60 days to enroll in their health insurance following the date that you lose or are denied Medicaid or MIChild (CHIP).

Learn more about Special Enrollment Periods for 2023 and 2024.

How much does Marketplace / HealthCare.gov insurance cost?

You will need to pay for Marketplace/HealthCare.gov coverage, but costs vary.

When you enroll, the Marketplace assesses your eligibility for tax credits based on your income, household size and eligibility for other insurance. These credits can be paid to your chosen insurance provider to cover some or all of your monthly premium. You may also qualify for reduced costs based on your income.

The Marketplace has an easy-to-use estimator tool. The estimator tool is not as accurate if you are not a US citizen but have an eligible immigration status for Marketplace tax credits.

We can help! Make an appointment by calling 734-544-3030 or emailing us at whp@washtenaw.org.

Do I have to renew Marketplace / HealthCare.gov insurance?

Marketplace/HealthCare.gov will automatically renew you, but if your current plan is not available, it will automatically enroll you in a similar plan. The plan that you are auto-enrolled in might not meet all your needs, and the costs might vary from your previous plan. It’s best to log in to HealthCare.gov during Open Enrollment Nov. 1 – Jan. 15 each year and make sure your plan still works for you, and change to a better option if it does not.

Make sure you’re choosing the best option by updating your information in the estimator tool and compare the new plans. Washtenaw Health Project staff start scheduling appointments (to help with new and renewal applications) in October.

If you qualify for a Special Enrollment Period, you can change your plan. Your eligibility notice states the last day you have to choose your coverage.

Washtenaw Health Project can help you!