Getting Insurance Through the Health Insurance Marketplace

If you do not have health insurance or if you might lose it, it is important to learn about a law called the Patient Protection and Affordable Care Act.

Most US citizens and legal residents are required by law to have health insurance.

You and your family might be eligible for:

• Medicaid
• Low-cost insurance
• Tax credits that are applied to the cost of your insurance premiums

The Health Insurance Marketplace

If you do not already have health coverage, the Health Insurance Marketplace (HealthCare.gov) can help. It is a way to find and buy health insurance that fits your budget and meets your needs.

• In the Health Insurance Marketplace, you can view and compare health insurance options online.
• You can sign up during the open enrollment period. It usually starts toward the end of each calendar year and lasts for a few months. During that time, you may sign up for coverage for the following year.
• A change in your life might make you eligible to enroll outside the open enrollment period. 
• Examples of these changes are:
  • Moving to a new state
  • Certain changes in your income
  • Changes in your family size (such as getting married, divorced, or having a baby). 
  • Learn more at HealthCare.gov.
• The Health Insurance Marketplace offers insurance plans from private companies. You can compare the price, benefits, quality, and other features of the companies.

How to apply 

With one application, you can find options that fit your needs. Based on your income, you can find out if you can get financial help to lower your costs.

The same form will let you find out if you and your family members might qualify for free or low-cost insurance coverage through Medicaid or the Children’s Health Insurance Program.

There are 4 ways to apply:

• Online: Visit HealthCare.gov
• By phone: Call 1-800-318-2596
• By mail: Write Health Insurance Marketplace, Dept. of Health and Human Services, 465 Industrial Blvd., London, KY 40750-0001
• Certified application counselor: St. Jude has access to a counselor that can offer help. Call them at 901-595-2670 or email applicationcounselor@stjude.org.
• Some patients and families may not qualify.

Benefits of the law 

Each health plan must offer a set of benefits that include:

• Doctor visits
• Preventive care
• Maternity care
• Hospital care
• Prescription drugs
• Laboratory services

The law also says that:

• Health insurance companies selling plans through the Marketplace cannot deny you coverage or charge you more if you have a pre-existing health condition. They also cannot charge women and men different amounts based on their gender.
• Parents will be able to keep their children on their health plans until age 26.
• Insurance companies cannot deny insurance coverage to those who are already sick or have a medical condition. They also cannot say that they will not cover the illness or medical condition.
• Insurance companies cannot cancel your insurance when you get sick (as long as your insurance bill is paid).
• Insurance companies cannot put lifetime limits on the dollar amount of your medical coverage for the core set of essential health benefits (as long as your insurance bill is paid).