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Health Insurance Marketplace

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Open enrollment for 2015 begins November 15, 2014 and runs through February 15, 2015.  
  • Health Insurance Marketplace

    • What is the Health Insurance Marketplace?
      • Navigate

        The Health Insurance Marketplace (sometimes referred to as the Health Insurance Exchange) is an online marketplace that allows you to purchase health insurance at a competitive rate and maybe even qualify for lower costs. 

        The Marketplace offers a solution for people who are currently uninsured. It may even offer a better option for some who are paying for high cost health insurance now. It is designed to be a "one stop shop" option where you can compare policies sold by different companies. Purchasing insurance can be confusing, so information on the plan benefits is standardized so that it is easier for you to compare costs and quality.

        Enrolling through the Marketplace is the only way you can qualify for help paying your insurance costs, based on your income and family size.

    • Why is this important?
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        Most people are required to have health insurance or pay a tax penalty. For those who are uninsured now or who are paying a high cost for current insurance, the Health Insurance Marketplace offers a great option for affordable health insurance coverage.

    • What is the benefit of using the Marketplace?
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        The Marketplace was created to make the process of selecting health insurance easier to understand and to provide affordable options.

        • All health insurance plans on the Marketplace must cover essential health benefits, making it easier to compare policies.
        • Insurance companies on the Marketplace can’t charge more or deny coverage because of pre-existing conditions or gender.
        • Plans sold through the Marketplace cannot have annual or lifetime limits on health insurance coverage.
        • The Marketplace also helps people who can’t afford the full cost of insurance by providing cost savings that will lower the amount they have to pay.
        • The amount of your cost savings depends on your income and family size.
    • Is CareSource part of the Marketplace?
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        CareSource is a "Qualified Health Plan" or "QHP" on the Health Insurance Marketplace in Ohio, Kentucky, West Virginia and Indiana for 2017 enrollment, which begins November 1, 2016.

        To be designated as a QHP, health insurance companies must meet rules established by the government as part of the Patient Protection and Affordable Care Act, also known as health care reform.

        CareSource is a nonprofit organization. We pride ourselves on understanding our members and helping them understand and access their health insurance services. CareSource has over 25 years of experience with managed health care coverage. We serve more than a million members. We are focused more on people than profits.

    • How do I access the Marketplace?
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        Visit to learn about the health care laws and their impact on you.

        If you have a qualifying life event, such as the birth of a child or loss of other health coverage, you can enroll during a special enrollment period.

        Open enrollment for 2017 starts November 15, 2016, when you can apply for coverage, compare available health insurance plans and enroll in a plan.

    • Do I have to buy insurance through the Marketplace?
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        Federal law requires most people to have health insurance or pay penalties. This is part of the Patient Protection and Affordable Care Act, otherwise known as health care reform. 

        So, while you do not have to buy insurance from the Health Insurance Marketplace, most people have to be covered or pay a penalty. Using the Marketplace allows you to compare available plans, ensure you receive essential health benefits and determine your eligibility for cost savings.

    • Where can I get more information?
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        We will continue to update information about the Health Insurance Marketplace on this website, so come back often.  

        You can find more information at

  • Eligibility

    • Who is eligible for the Marketplace?
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        Three requirements must be met to be eligible for health insurance through the Marketplace:

        • You must live in the U.S.
        • You must be a U.S. citizen or national (or lawfully present).
        • You can’t be currently incarcerated (serving time in jail).
    • Can I provide coverage for my family through the Marketplace?
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        Yes, some health insurance plans will offer family coverage and others will offer individual coverage for each member of your family. This allows you to customize your health insurance coverage so that it fits the needs of you and your family.

    • Can I provide coverage for my adult children?
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        If your children are under age 26 and meet certain requirements, you can insure them under your family policy if the health insurance plan covers dependents. This is true even if your children live on their own. Coverage up to age 26 is only a minimum. State rules and individual insurance plans can extend dependent coverage past age 26.

        Before the health care reform law, insurance companies could stop covering dependent children at age 19 or when they were no longer full-time students.

    • I can get insurance through my employer. Can I buy insurance through the Marketplace?
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        Individuals who can get insurance through their employers can buy insurance through the Marketplace if their premiums are unaffordable (more than 9.5 percent of their household income) or if the plan is inadequate (pays less than 60 percent of the cost of covered benefits).

  • Coverage

    • What health care benefits are covered through the Marketplace?
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        In general, essential health benefits are covered under the plans offered through the Marketplace. All plans cover the following services:

        • Free preventive and wellness services (such as mammograms, diabetes screenings, flu shots and more)
        • Prescription drugs
        • Outpatient services (such as primary care and specialty doctor visits, urgent care services, diagnostic testing and more)
        • Hospitalization (such as surgery)
        • Emergency services
        • Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
        • Pediatric services including dental and vision care for kids
        • Maternity and newborn care
        • Laboratory services (such as blood drawn)
        • Rehabilitative and habilitative services and devices (to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

        Some plans provide additional benefits, for example, adult dental and vision care. Plans range from basic with minimal coverage to all encompassing high-end plans.

    • Will pre-existing conditions be covered?
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        The health care laws are designed to protect you and your family. Health insurance companies can't refuse to cover you just because you have a chronic or pre-existing condition. In addition, they can’t charge more for women than for men. All of the plans offered through the Marketplace comply with these health care laws.

    • Are preventive services such as vaccines for children or mammograms for women covered?
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        Yes. All health insurance plans offered through the Marketplace cover preventive services at no cost to you. This means you do not have to pay a copayment or coinsurance even if you haven't met your yearly deductible.

        Preventive services are designed to prevent, identify and treat diseases early. These include flu shots and immunization vaccines, screenings to identify diseases, contraception and mammograms for women, behavioral assessments for children and much more.

    • Are there lifetime limits on the amount that insurance companies will cover?
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        No. Insurance companies cannot impose annual or lifetime dollar limits on essential health benefits. In the past, people with cancer or other chronic illnesses could run out of insurance coverage because insurance companies could limit the amount they would pay during a year or over a lifetime.

  • Enrollment/Reenrollment

    • What is the time frame for buying insurance through the Marketplace?
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        If you have a qualifying life event, such as the birth of a child or loss of other health coverage, you can enroll during a special enrollment period, which ends 60 days after the life event.

        Starting on November 1, 2016, you can enroll in a health care plan for 2017 through the Marketplace during open enrollment. You must enroll by December 15, 2016, if you want new coverage to begin January 1, 2017.

        Open enrollment will close on January 31, 2017. This means that you will have three months, from November 1, 2016 to January 31, 2017, to buy health insurance from the Marketplace. Remember, you must have health insurance or pay a penalty.

    • What information do I need to enroll in the Marketplace?
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        In order to enroll through the Marketplace, you will need the following information for each family member to be covered:

        • Social Security number or document number for legal immigrants
        • Employer and income information, for example, wage and tax statements from pay stubs or W-2 forms
        • If currently covered by health insurance, the policy number
        • If eligible for employer health insurance coverage (even if the coverage is through another person’s job, for example, a spouse’s or a parent’s) information about the employer’s health insurance plan
        • If you had Marketplace coverage in 2016, you’ll need plan materials from your current plan that contain your Plan ID
    • Can I enroll in a Marketplace plan without using the internet?
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        Yes. You can apply by phone 1-800-318-2596 (TTY: 1-855-889-4325), by mail (Health Insurance Marketplace, Attn: Coverage Processing, 465 Industrial Blvd, London, KY 40750-0001) and in person during open enrollment.

    • I am currently enrolled in a Marketplace plan. Do I need to reenroll?
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        It depends on the state you live in. If you had a Marketplace plan and you live in Kentucky, you will need to reenroll for 2017 through the Health Insurance Marketplace at

        If you bought coverage through the Marketplace in 2016, you will be notified if you are eligible to continue with the same coverage in 2017 and if your options for financial assistance have changed.

        This process begins when the Marketplace sends you an annual redetermination notice. You need to review, sign and return this notice promptly. If any of the information is inaccurate, contact the Marketplace. If you do not sign and return the notice within 30 days, the Marketplace will assume the information is correct.

        The Marketplace will then notify you with a final decision regarding eligibility for coverage and financial assistance, including whether you are eligible for programs such as Medicaid or the Children’s Health Insurance Program (CHIP).

        If you are eligible to continue to receive Marketplace coverage, you can either keep your current plan or change plans during open enrollment, which is November 1, 2016 to January 31, 2017. You will be automatically reenrolled in your current plan if you do nothing. If your current plan’s benefits have changed, you will be notified of these changes.

    • Can I keep the Marketplace plan I selected in 2016?
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        You can still keep the same plan you selected, but if you live in Kentucky you need to reenroll.

        If you enrolled in a Marketplace health insurance plan last year and the Marketplace has determined that you remain eligible for Marketplace coverage, you will be automatically reenrolled in the same plan for 2017 that you selected for 2016. If the cost or coverage details of your plan have changed from 2016 to 2017, your insurance plan will notify you of these changes.

    • Can I switch to another Marketplace plan for 2017?
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        If you enrolled in a Marketplace health insurance plan last year and the Marketplace has determined that you remain eligible for Marketplace coverage, you can change to another Marketplace plan during open enrollment, which is November 1, 2016 to January 31, 2017. To change plans, go to the Marketplace, access your account, shop for plans and select the plan that best suits your needs.

  • Costs

    • How much does Marketplace insurance cost?
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        The cost of health insurance through the Marketplace depends on the plan you choose, your age and your tobacco use. Regardless of the plan you choose, all costs are stated up front so you’ll know how much you’ll be paying and what you’ll be getting before you make a choice.

        You may qualify for tax credits that will lower your monthly payments based on family income and size. The Marketplace will show you the amount of these lower payments when you enroll starting November 1, 2016.

    • How can I determine if I qualify for lower costs?
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        You will be able to determine if you qualify for lower costs when you enroll through the Marketplace starting November 1, 2016. The Marketplace will tell you if you qualify for Medicaid, the Children’s Health Insurance Program (CHIP) or a tax credit.

    • How can the Marketplace lower my monthly premium payments?
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        When you buy health insurance coverage through the Marketplace, you may be able to get a premium tax credit or subsidy that can lower the amount you pay each month for your premium. The amount of your tax credit depends on your household size and income.

        When you enroll through the Marketplace, you will find out the amount of your tax credit. At that time, you can choose to apply the amount equally to your monthly premium payments or you can wait until you file your federal tax return.

        If you apply the amount to your monthly premium, you get the benefit of lower monthly payments throughout the year. If you apply some or all of your tax credit to next year’s tax return, you increase your chance of getting money back at tax time.

    • Are there other cost savings I could qualify for?
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        Yes. In addition to the tax credit that reduces your monthly premium payment, you may qualify for cost sharing reductions. If you qualify for these, you will pay lower out-of-pocket deductibles, copayments and coinsurance if you choose a health plan from the Silver category.

    • What if I qualify for cost savings through the Marketplace and my income changes after I enroll?
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        When you enroll, you estimate your earnings for next year, and this estimate determines your cost savings. You must report any income change, up or down, that impacts your eligibility for cost savings to the Marketplace at Otherwise, you may miss out on the cost savings or end up owing money if you no longer qualify for the cost savings.

        So, if your income changes your estimated earnings for the year, for example, through a job change or job loss, you should report it to the Marketplace.

        You must also notify the Marketplace in the following situations:

        • If you become pregnant
        • If you have a baby
        • If your address or phone number changes
        • If your immigration status changes
        • If your marital status changes
        • If you become eligible for other health care coverage
    • How much is the penalty if I don’t have health insurance?
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        If you don't have health insurance coverage, you may have to pay a penalty at tax time. This penalty is also referred to as the "individual responsibility payment" or "individual mandate." You also have to pay for all of your health care.

        The fee is calculated two different ways: as a percentage of your household income, OR per person.

        2016 Penalties (2017 penalties will be adjusted for inflation): 2.5% of household income, OR $695 per adult/$347.50 per child under 18.

        You’ll pay whichever is higher.

  • Health Insurance Basics

    • What is insurance?
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        Insurance protects you from high costs when something bad happens. No one plans to get sick or hurt, but most people need to get treated for an illness or injury at some point, and health insurance helps pay these costs. You get health insurance to protect you when you need medical care.

        When you understand how health insurance works, it helps you be an informed consumer so you can find coverage that fits your needs.

    • What is health insurance?
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        Health insurance is a contract between you and your insurance company. You buy a plan or policy, and the company agrees to pay part of your medical costs when you get sick or hurt. Even when you need care that costs more than you pay in premiums and deductibles, insurance will cover the care you need. A standard health insurance plan also gives you access to preventive care to keep you healthy, like vaccines and check-ups. Many plans also cover prescription drugs.

        Your health insurance plan will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations.

    • How do you pay for health insurance?
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        You’ll usually pay a premium every month for health insurance, and you may also have to pay a deductible once each year before the insurance company starts to pay its share. How much you pay for your premium and deductible is based on the type of insurance you have.

        Just as important as the premium cost is how much you have to pay when you get services. Examples include:

        • How much you pay before your insurance coverage starts (a deductible) 
        • What you pay out-of-pocket for services after you pay the deductible (coinsurance or copayment)
        • How much in total you’ll have to pay if you get sick (the out-of-pocket maximum) 

        What your policy covers is often directly related to how expensive the health insurance policy is. The policy with the cheapest premium may not cover as many services and treatments.

    • What is a premium?
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        A premium is an amount you pay for your insurance plan each month. You pay this amount even if you don't use medical care that month. Your health insurance premium is similar to your auto insurance premium. You pay it monthly so that you are covered when you need it.

    • What is a deductible?
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        A deductible is an amount some insurance plans require you to pay once each year before the insurance company starts to pay its share. For example, let's say you have a $200 deductible. You go to the doctor and the total cost is $1,000. You pay the first $200 to cover the deductible, and then your insurance pays the remaining $800.

    • What is coinsurance or a copayment?
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        Coinsurance or a copayment is an amount that you pay as your share of the cost when you get a medical service, like a doctor's visit or a prescription. Coinsurance is usually a percentage amount (for example, 20% of the total cost). A copayment is usually a set dollar amount (for example, you might pay $10 or $20 for a prescription or doctor's visit).

    • What is an out-of-pocket maximum?
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        This is the maximum amount that you could pay for medical care that is not reimbursed by insurance. Out-of-pocket costs can include deductibles, coinsurance and copayments for covered services. After you've reached your out-of-pocket maximum, your insurance plan must pay for all of your covered medical care with no limit.

    • Are all health insurance plans the same?
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        No. There are many kinds of health insurance plans. Some plans allow you to visit almost any doctor or health care facility. Others limit your choices to a network of doctors and facilities or require you to pay more if you see doctors outside the network.

        It is important to understand what each plan covers, the terms of the plan and any limitations before you purchase a plan. The Summary of Benefits and Coverage (SBC) provides information about health plan coverage in a common format so you can easily compare plans.

    • Why is it important to have health insurance?
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        A single visit to a primary care doctor can cost between $150 and $200. The average cost of a 3-day hospital stay is $30,000. Fixing a broken leg can cost up to $7500. Having health insurance coverage can help protect you from high, unexpected costs like these. People without health coverage are exposed to these costs, which can sometimes lead people without coverage into deep debt or even into bankruptcy.