Basics of the Marketplace
What is the Open Enrollment Period?
What is the time of year when people can sign up for or change their Marketplace coverage.
What is the income limit for premium tax credits?
Between 100% and 400% of the federal poverty level (FPL) for most people.
Name two types of plans available on the Marketplace.
Bronze, Silver, Gold, and Platinum.
Can someone apply for Marketplace coverage if they already have Medicaid?
No, those with Medicaid aren't eligible for Marketplace coverage.
What is the official deadline for consumers to pay their first premium to activate their coverage through the Pennie Marketplace?
What is before the coverage start date?
When is the Open Enrollment Period?
What is November 1 to January 15
What is the Advance Premium Tax Credit?
A tax credit that lowers monthly premium costs for eligible enrollees.
Which Marketplace plan has the lowest monthly premiums?
Bronze Plans
What essential health benefits are required by PA's Marketplace plans? Name 2
Ambulatory patient services, emergency services, hospitalization, maternity care, mental health services, prescription drugs, rehab and rehabilitative services and devices, laboratory services, preventive services, and pediatric services
What is the purpose of PA's Insurance Marketplace?
To help Pennsylvania residents find and enroll in affordable, quality health insurance.
What is a Special Enrollment Period?
What is A time outside of Open Enrollment when people can sign up for Marketplace coverage if they experience certain life events
What is cost-sharing reduction (CSR)?
A subsidy that reduces out-of-pocket costs for eligible individuals with Silver plans.
Which type of plan is generally recommended for people who expect high medical expenses?
Gold or Platinum plans
What happens if a consumer doesn't reconcile their APTC during tax filing for the previous year in Pennsylvania?
They may become ineligible for APTC in the following year if they fail to file or reconcile their APTC on their federal tax return.
How can someone cancel a Marketplace plan if they get other coverage?
They can log into their Marketplace account and follow the cancellation instructions, get assistance from a broker, or call the Pennie Marketplace.
Name one life event that qualifies someone for a Special Enrollment Period.
What is getting married, having a baby, losing other health coverage, etc?
Who is eligible for Medicaid through the Marketplace?
Individuals with income at or below 138% of the FPL.
Children whose family income is at or below 205% of the FPL.
What does 'out-of-pocket maximum' mean?
The most a person will pay in a year for covered services.
How does PA's Marketplace define an "affordable" employer-based plan for subsidy eligibility?
A plan is "affordable" if the employee's premium for coverage in 2025 is less than 9.02% of household income.
Name two services agents provide.
What is assistance with application and enrollment; answering questions about Marketplace plans.
How many days do consumers generally have to apply after a qualifying life event?
What is 60 days
What's the maximum household income to be eligible for Marketplace assistance if they don't qualify for Medicaid?
Up to 400% of the FPL for premium tax credits.
Do Marketplace plans cover pre-existing conditions?
Yes, all Marketplace plans cover pre-existing conditions.