The Individual Mandate under the Patient Protection and Affordable Care Act (PPACA) requires all American citizens to purchase or be entitled purchase healthcare coverage either thru private insurance or a government subsidized program such as the Marketplace (i.e. on‐exchange) or Medicaid under new expansions nationwide. The new law passed in March of 2010 requires everyone to have coverage or face federal penalty.

At Insurance Exchange Navigators (IEN) we realize the importance of having the available knowledge, experience, and guidance for our clients to follow when finding their way thru this new and complicated system for purchasing healthcare. Our organization has helped thousands of households in Ohio with purchasing PPACA compliant plans and policies since they began in January of 2014. As an independent firm, IEN can assist customers with finding solutions on and off the insurance exchange as well as from nearly any insurance carrier.

Each year, the federal health insurance open enrollment period begins in November and goes thru the end of January. At this time Americans can shop the Marketplace or different private insurance carrier plans for different options, coverage, and premiums. This is now the only time of year which a person may make changes or purchase health insurance outside of a Special Election Period (SEP).

Serious factors to consider when purchasing health insurance in today’s new marketplace are items such as household income, number of dependents living in your household, and whether or not anyone uses tobacco. There are no longer health questions or preexisting condition concerns when applying for coverage. All plans are now guaranteed issue.

As for whether or not you make your purchase on the Marketplace Exchange depends mainly on whether or not your household income is at or below 400% of the current federal poverty level. The chart below provides a rough estimate of where the income level may need to fall given the number of people inside the household.

Depending on your family’s percentage of federal poverty level, you may qualify for a greater monthly subsidy to help pay the monthly health insurance premium as well as a possible second qualification to receive the Cost Sharing Subsidy from the Affordable Care Act which helps families cover some of the out of pocket costs such as deductibles and coinsurance. Our staff can help assist you with defining all of your different variables in order to come to a final conclusion of what is available to choose from and what subsidy qualifications your family may be entitled to.

For those who choose to try figuring the new health insurance purchasing process out on their own, we highly recommend understanding that many insurance carriers have highly limited networks now and your doctor or hospital may not any longer be considered “in‐network”. Do not fall into the trap that just because you recognize the insurance carrier’s name and reputation that their network of doctors and hospitals has gone unchanged. Our consultants have seen many examples of people purchasing health insurance in Ohio whereas the nearest in‐network doctor or hospital is nearly 60 miles away from their home or residence. Buyer beware.

For further information or a consultation, please feel free to contact any one of our local offices found on our About Us page of this website.

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