What is the healthcare marketplace? What types of plans are available? Which plan is right for you? Are there important dates for open enrollment and other items? This article will review your essential questions about the healthcare marketplace and the outlook for 2023. Whether you are a healthcare worker, such as a nurse or a nursing assistant, or perhaps you don't work in the medical field, this article will still cover what you need to know about buying insurance in the Healthcare Marketplace in 2022.
What is the Healthcare Marketplace?
The Healthcare Marketplace also called the Health Insurance Marketplace, is an online shopping and enrollment resource established by the Affordable Care Act in 2010.
You can use this service at How to Get Marketplace Health Insurance | HealthCare.gov to do several things, including:
- Compare health insurance plans for coverage and affordability.
- Learn if you are eligible for tax credits for private insurance or public programs like Medicaid or the Children's Health Insurance Program (CHIP).
- Ask other questions about healthcare insurance, and enroll in a plan that meets your needs and budget.
What Healthcare Plans Are Available?
Although all the Marketplace healthcare plans provide the same fundamental benefits, including doctor appointments, preventive care, hospitalization, prescriptions, lab tests, and more, you will want to compare the variations in the choice of healthcare providers and price.
Four Plan Types Available in the Marketplace in Order of Cost
- Health Maintenance Organizations (HMOs) limit coverage to care from a network of doctors, hospitals, or specialists who contract with the HMO. You choose a primary care physician (PCP) and need a referral from your PCP to see a specialist or run specific tests. In general, it does not cover out-of-network care except for emergencies. You may be required to live or work in a particular area to be eligible. HMOs have no deductible (the money you must pay out of pocket before your insurance covers anything) or a very low one.
- Exclusive Provider Organizations (EPOs), similar to HMOs, limit the services to health providers in the plan's network except for emergencies. However, EPOs have a broader network than HMOs and do not require referrals for specialists. Typically, EPOs cost more than HMOs and less than PPOs.
- Point of Service Plans (POS) offer out-of-network and in-network coverage, but you need a referral from your PCP to see an out-of-network doctor, which is an additional cost. POS is the only type of plan that usually has no deductible.
- Preferred Provider Organizations (PPOs) also have in, and out-of-network coverage, but they are more flexible, allowing you to use doctors outside the network with additional cost and without a referral. Premiums and co-pay tend to be higher than in POS plans.
So, which plan should you choose?
Each plan type has advantages, so the choice depends on your health needs and budget. For more flexibility in your choice of providers, check out PPO or POS plans. An EPO plan may work better if you want a more extensive network but don't necessarily need out-of-network benefits. If you seek care in a particular geographic area and are looking for a lower price, consider an HMO plan.
It would help if you also asked some further questions.
- What hospitals and doctors are "in-network"?
- Does the plan cover my current medications?
- What is the deductible, and how much is the co-pay?
- Is there a maximum limit to the amount I might end up paying out-of-pocket?
- Is there a limit on the number of appointments or services?
- Is there a pre-existing condition exclusion?
Make sure to look at the Summary of Benefits and Coverage.
How Families and Clinicians Plan for The Upcoming Year?
Start looking into your options now and get ready to enroll because the Affordable Care ACT (ACA) Open Enrollment 2023 is coming up. For a practical guide, look at the Marketplace Healthcare Enrollment website.
What Are the Key Dates for the Health Insurance Marketplace?
- November 1, 2022, is the opening day for ACA Open Enrollment 2023 in most states, except in Idaho, where it already began on October 15, and in New York, where it starts on November 16.
- January 15, 2023, is the closing day for Healthcare Marketplace Open Enrollment, except in Idaho and Maryland, where it closes on December 15, 2022.
- December 15, 2022, is the last day to enroll if you want coverage to start in January 2023. Otherwise, if you enroll between December 15 and January 15, coverage will begin in February 2023.
It is the only time during the year that families or individuals (including clinicians) can sign up for an ACA-compliant health plan or switch to a different plan without needing a qualifying life event, such as changing jobs or having a baby.
Travel and Pro Re Nata or Per Diem (PRN) Nurses Need Insurance
Nurses need health insurance just like everyone else. However, employers only sometimes cover the insurance for these short-term employees because they earn a higher salary working as a per diem or travel nurse. While these nurses may not have as many health insurance options, three alternatives stand out:
- Short-term health insurance
- ACA-compliant plans such as a PPO or POS
- Agency-provided health insurance
Market Outlooks and Predictions for Healthcare Marketplace in 2023
Health plan costs are expected to rise 5.6% on average in 2023, lagging behind overall inflation, which is currently about 8.5 percent year-to-year.
ACA Marketplace enrollees have benefited from enhanced tax credits under the American Rescue Plan Act (ARPA) and temporary pandemic relief. These subsidies have already contributed to record-high marketplace enrollment and a record-low uninsured rate of 8% in early 2022.
Last August, Congress approved the extension of the enhanced subsidies for three more years through the end of 2025. HealthCare.gov, premium payments in 2022, and extending into 2023, would have been 53% higher on average if not for the ARPA extra subsidies.
The Health Insurance Marketplace is there to help you find the best health insurance option for you, no matter where you work, what you make, what type of organization you run, or your health needs. Nursa wants to ensure you check it out in time and find the coverage you need.