Health Insurance Marketplace – Open Enrollment

No one expects to get sick or be hospitalized with an illness or injury, but there is no way to plan for when it does happen. Health insurance can help.

What is the Health Insurance Marketplace?

According to HealthCare.gov, the Health Insurance Marketplace, also known as the Marketplace or exchange, is a service that helps people shop for and enroll in health insurance. While the federal government operates the Health Insurance Marketplace in most states, some states run their own Marketplaces. In Nebraska, residents enroll in coverage through Healthcare.gov, but the state oversees various aspects of the plans available for sale in the exchange. For the 2022 year, three plans will be available to choose from – Medica, Bright Health, and Oscar Health.

Who can use the Marketplace?

The Marketplace provides health plan shopping and enrollment services through websites, call centers, and in-person help for those individuals who live in the United States, are a U.S. citizen or national, are not incarcerated, do not have Medicare, and who meet the income requirements.

What are the two types of insurance plans, depending on income?

You may qualify for an insurance plan with tax credits or Medicaid/Children’s Health Insurance Program (CHIP) which provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Even if you do not qualify for Medicaid based on income, you should still apply as you may be eligible for your state’s program.

When is the open enrollment period for the Marketplace?

Open enrollment begins November 1 and runs through December 15 for coverage to begin on January 1, 2022.

Enrollments completed between December 16 and January 15, 2022 will have coverage starting February 1, 2022. It should be noted that November 1 – January 15 is a longer than usual enrollment period.

It is strongly recommended to actively participate in the open enrollment and not allow the marketplace to automatically re-enroll you in your current plan as this may put you at a disadvantage. Updating your application during open enrollment is encouraged, even if personal circumstances have not changed, in order to see all current plans and financial assistance options.

What services do Marketplace health insurance plans cover?

All plans offered in the Marketplace cover these 10 essential health benefits:

• Ambulatory services (outpatient care you receive without being admitted to a hospital)
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care
• Mental health and substance use services
• Prescription drugs
• Rehabilitative services
• Lab services
• Preventive, wellness, and chronic disease management services
• Pediatric services

Birth control coverage and breastfeeding services must also be included. While not considered essential, some plans may also offer dental and vision services. It is important to compare plans and note which services are offered.

How do I compare plans, determine costs, and enroll?

Go to HealthCare.gov and click on “preview available plans and estimated prices based on income” located under Tips about the Health Insurance Marketplace section. HealthCare.gov will also walk you through the enrollment process regardless if you are new to the Health Insurance Marketplace or already have an account.

Bluestem Health patients can also contact our Patient Support Services for additional Marketplace open enrollment assistance, if needed. The team at Bluestem Health encourages those who are eligible to apply and enroll in the Health Insurance Marketplace well in advance of the December 15 deadline to give yourself time to thoroughly compare plans, ask any questions you may have, and ensure you have coverage beginning January 1, 2022.