- Often the method to make your first insurance payment (called the binder payment) for a Marketplace policy is different from the subsequent payments. This means you will receive an invoice every month unless you contact your insurance company and arrange for an automatic draft from your checking account, savings account, credit card or debit card.
- Make sure you register on the website of your health insurance company. Although you will have a customer service number, this will give you a chance to view your claims, pay your premiums, set yourself up on autopay and find in network providers.
- Read your Marketplace Letter carefully. The Marketplacesometimes requires you to provide additional information several weeks after your policy begins. The type of information can be proof of your income, citizenship, identity or proof that you are in the U.S. legally. Even if you are paying your insurance premiums on time, the Marketplace will stop your government subsidy if you do not comply with their requests. This information can be uploaded to their website or mailed. If you mail it, make sure you follow their guidelines and include the barcode in Marketplace letter. Normally your insurance agent can upload your documents on your behalf.
- When you apply for a government subsidy you provide an estimate of your Modified Adjusted Gross Income (MAGI). Your subsidy is based on your MAGI, age, zip code and household members. Every January the Marketplace will mail 1095 A forms to heads of households receiving a subsidy. The information on the 1095 Ais used to complete the 8962 form, which is used to reconcile the estimated income that you provided to the Marketplace with your actual income. If you don’t receive the 1095 A form, you can retrieve it at gov, call the Marketplace at 1 800 318 2596 or contact your agent. Even if you are only on a Marketplace policy for a short period you are required to complete this form. Failure to do this can prevent you from obtaining a subsidy in the future.
- If you have a change in circumstances such as a new job where you make a higher income or are offered health insurance, make sure you contact the Marketplace. A higher income needs to be reported because your new income could cause you to lose all or part of your subsidy. If your new job offers health insurance that is compliant with the Affordable Care Act,you are not allowed to receive subsidy unless your premium is considered unaffordable by the Marketplace.. Failure to comply with this policy could cause you to pay an IRS penalty.
- Do not call your health insurance company to cancel your health insurance policy. Instead call the Marketplace at 1 800 318 2596. Once the Marketplace receives your request, they will contact your insurance company and cancel your policy. Since the Marketplace will cancel your policy the day you call, make sure you call the day your new health plan starts.
- Changes such as your marriage status, dependents, a member becoming eligible for Medicare or address should be reported to the Marketplace immediately since these changes can affect the amount of your subsidy, policies available and your premium.
- If you plan a trip outside of the United States, make sure your policy will provide the medical coverage you need. You may need to purchase Medical Trip Insurance.
- To ensure you pay the lowest amount for your prescription drugsmake sure you use one of your plans preferred pharmacies or their preferred mail order.
- If your doctor recommends you take a new drug that is not in the formulary of your current Plan,you can contact their customer service and request an exception. Also, you can shop around for the best price. Online applications like com, GoodRx.com and Singlecare.com often have coupons that offer significant savings. You may be able to get a lower cost through discounts at a local pharmacy, an on-line pharmacy like Amazon Pharmacy, Mark Cuban’s pharmacy, Costplusdrugs.com or Marley Drugs (https://www.marleydrug.com, 1 866-997-2871). From this website: www.needymeds.org, people often find huge savings on expensive drugs. This organization helps them connect with the manufacturers of expensive drugs to obtain them at no cost or a low cost. Their number is 1 800-503-6897. Another option is to order your drug from a Canadian pharmacy like Canadian Prescriptions Plus (1-866-779-7587, www.canadianprescriptionsplus.com).
- Before Marketplace Open Enrollment, which is normally between November 1st and January 15th, you should receive a letter from the Marketplace and your insurance company. The Marketplace may have made changes that could affect your policy decision. Your insurance company may have a rate increase or changes in their provider network that may affect you positively or negatively. They may terminate your plan or no longer be participating in the Marketplace. If you have had changes in your health, income, medical providers or your prescription drugs, you may want to change to a different policy. Contact your insurance agent or the Marketplace if you need assistance updating our information.
