What Do I Need to Do If I Enroll in a Marketplace?

If you've decided to enroll in health insurance through a marketplace ("exchange"), you may have questions about what to do next. Here's a handy checklist to help you stay on track as you weigh your options:

Decide which family members you want to cover.

  • You
  • Your eligible spouse or, if eligible, domestic partner
  • Your eligible child(ren) up to age 26

Choose the level of insurance you want.

  • Bronze
  • Silver
  • Gold
  • Platinum

One level isn't necessarily better than another. The plan levels just provide different types of insurance, at different costs, to fit different needs. In general, you'll pay the lowest premiums for a Bronze plan. In return, the amount you'll pay out of your own pocket when you use medical services will be the largest of the four levels. As you move from a Silver to a Gold to a Platinum plan, your premium costs will increase. In return, the amount you'll pay out of your own pocket when you use medical services will be increasingly smaller. Keep in mind: Under the Affordable Care Act, in-network preventive care services are covered at no cost to you, no matter which plan you choose. Are you under age 30? You'll have an additional option: a "young invincible" plan. This type of plan offers a safety net to protect you against unexpected, high medical costs, such as for hospital care or serious illness. It costs much less than the metallic plans.

Choose your insurance company.

  • Think about the cost per month. Just like shopping for a flight on a travel website, you'll be able to see all of your options and prices in one place. That makes it easier to compare your options and find the best fit for your family's needs.
  • Find out if your doctors or other providers are in the plan's network. Why? Because you'll pay less for care that you get from in-network providers. Even if you want to continue with your current insurance carrier, the provider network could be different, so always double-check before making a decision.
  • Understand how your prescription drug coverage will work. Each plan may have its own rules about how and which drugs are covered, so you need to make sure you're comfortable with those rules.

For example:

  • Is your drug on the plan's list of preferred drugs? (This list is known as the "formulary.")
  • Will you be required to use generic drugs?
  • Will you need to get the plan's approval before it will cover certain drugs?

Enroll

November 1, 2015: Open Enrollment starts -- the first day you can enroll in coverage that starts January 1, 2016
December 15, 2015: The last day to enroll for coverage that starts January 1, 2016
January 15, 2016: The last day to enroll for coverage that starts February 1, 2016.
January 31, 2016: The last day to enroll for 2016 coverage. If you miss this deadline, you can’t sign up for an exchange based health plan for the rest of 2016. The only exception is if you qualify for a Special Enrollment Period.