Marketplace Coverage

I want to clear up a misunderstanding that a lot of people have about the Marketplace.

I received a call from a client, who had recently done their taxes, which prompted me to realize that many people do not understand the dynamics of Marketplace and how:

  • Adjusted gross income
  • Income from varying sources
  • Taxes

…all contribute to how you qualify for the Marketplace.

The important thing to remember is that anybody can have Marketplace coverage.

What matters is how much you pay for that coverage.

If you make too much money, you might not qualify for a subsidy. This just means you pay full price for the premium.

If you make too little, you can still get the coverage, but you will not pay the full price.

Essentially, the amount that you pay depends on your income and household size.

I’ve talked about this before:

  • Tax
  • zip code
  • household size

These all affect the cost of the premium. But what doesn’t change is that Marketplace is available to everybody.

You do not even have to put in your income in the Marketplace application if you just want to buy insurance. If you do not want to see if you qualify for the tax credit, you can do that and you just pay whatever the price is.

Remember, just because you don’t qualify for a subsidy or, you’ve had a subsidy and now you don’t qualify for a subsidy, that does not mean you cannot have Marketplace coverage. It just means you’re going to pay something different for that same exact coverage.

How would I handle a situation with a client who is concerned and presumes they won’t qualify for a subsidy?

  • First, I input what their actual income is now
    • People get very confused by that even though I try to explain it.
    • Knowing what your adjusted gross income is, is very important.
    • Whether you get it from job investments or passive income, all those things play into your adjusted gross income. And that’s the total that we need to use for your premiums.
  • Then I would assist the client in picking plans accordingly, based on budget and which subsidies they did or did not get approved for.

So remember, everyone can have marketplace insurance.

Remember too, that there are also certain times that you can enroll in Marketplace, but everyone can have it, even Medicare people, if they don’t want Medicare. (I don’t know why you would do that. But if you don’t want Medicare, you come by Marketplace, you’re just going to pay for it.)

We just need to check to see if you qualify for a subsidy but every single person can sign up for Marketplace coverage.

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