First and foremost: Do I Understand This Stuff?
Look, no one understands everything. I’ve talked to people with Master’s degrees who just cannot wrap their heads around the difference between ‘copay’ and ‘coinsurance’. It doesn’t mean you aren’t smart – but it may mean you need help making your plan selection.
Unless you are certain that you can pay your costs out of pocket – your pocket – if the plan doesn’t work like you think it should you need professional assistance before buying a plan. You can either try to learn this stuff – or you can pick up a phone and call a broker. Either will work – but if you’re pushing a deadline, call the broker and let them help pick this year’s plan. You’ll have plenty of time to study up for next year!
If the word ‘insurance’ makes you reach for the Tylenol, getting help from a broker or enrollment center is the smart plan. You’ll save time, money and frustration.
Second: What Are My Financial Expectations?
If you know you’re in an income bracket that makes you ineligible for Advance Premium Tax Credits, the Marketplace has little to offer you beyond some convenience comparing plans from different companies. The Marketplace adds a layer of bureaucracy between you and your insurance company – if something goes wrong, the convenience shopping will be offset by the inconvenience of having to deal with both the Marketplace and the insurance company. That doesn’t mean you can’t use the Marketplace – just realize that its key benefit – tax credits – isn’t going to apply to you.
If you aren’t sure, or your income varies so that you can’t be sure, going through the Marketplace may be worthwhile – doing so means you will be able to recoup the tax credit if it turns out that you were eligible. This one is a judgment call – a potential tax credit versus a potential headache and no assurance either way. Use the tools on the Marketplace website and try various reasonable possibilities for your annual income – if most come out with a tax credit, the Marketplace may well be right for you.
If you know you’re eligible for a tax credit but want to collect it in your tax refund then you must go through the Marketplace. Just make sure the tax credit is not applied to your enrollment – call the call center before you complete the enrollment if you aren’t certain!
If you know you’re eligible for a tax credit and need it to help pay for your plan, the Marketplace is exactly what you need. Only Marketplace plans work with an Advance Premium Tax Credit!
If you aren’t sure you make enough money to be eligible, apply to Medicaid first (in some states you can go through the Marketplace website to apply to Medicaid). If you are Medicaid eligible you are not eligible for tax credits – but you have insurance so you don’t need them! If you are not Medicaid eligible and didn’t apply through the Marketplace, go to the Marketplace to apply for tax credits to help you buy your plan.