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Navigating the Healthcare Marketplace: Tips for First-Timers

Independent Health Agents in TX

Navigating the healthcare marketplace, also known as the Health Insurance Marketplace, can be intimidating. The abundance of options may stress and overwhelm you are not familiar with the Affordable Care Act (ACA). If you’re new to the application process, you may be uncertain of what to look for and how to get started. 

Before you begin, learning about the basics helps you to be prepared and find the policy that’s most appropriate for you. So, our experts in the healthcare marketplace, My Healthcare Direct, have developed an informative guide with tips for first-timers in the healthcare marketplace. 

image of healthcare marketplace concept 2

Open Enrollment Periods

As a healthcare marketplace newbie, it is useful to know when to apply. Prior to starting an application, you must be aware of the open enrollment period. Otherwise, you may experience difficulties receiving coverage. The marketplace enrollment period typically extends from November 1 to January 15 each year. 

However, those who enroll by midnight on December 15 can receive full-year coverage on January 1. Those who register after December 15 but before the January 15 deadline will have coverage that starts on February 1.

What Healthcare Marketplace Plans Cover

Most marketplace plans cover the following:

  • Prescription drugs 
  • Emergency services 
  • Hospitalization
  • Laboratory services
  • Rehabilitation/habilitation
  • Preventative treatment and chronic disease management
  • Mental health care 
  • Substance use disorders
  • Pediatric care
  • Free preventative health services for all adults, women, and children when delivered by a doctor or provider within the network. For instance, adults can receive free screening for hepatitis, mental health issues, HIV, or high blood pressure.

Healthcare Premiums & Deductibles

Most health insurance policies have monthly premiums. So, as first-timers, they might find navigating the marketplace challenging. 

Premiums are the monthly amounts billed that policyholders pay for coverage. They must be paid regardless of whether they visit a doctor or receive other healthcare services. Lastly, the costs vary depending on the plan. 

In comparison, deductibles are costs the policyholder must pay deductibles upfront before the health insurance initiative coverage. Once the deductible is met, most individuals only pay a copayment or coinsurance for additional healthcare services based on an out-of-pocket maximum. This predetermined amount must be paid before the insurance covers 100% of an individual’s in-network expenses. 

That’s why it’s beneficial to be aware of the out-of-pocket expenses to find the insurance that best fits your budget.

Types of Healthcare Marketplace Plans

Navigating the healthcare marketplace involves understanding what types exist, which include:

Health Maintenance Organization (HMO)

HMOs provide integrated care, focusing on prevention and wellness. They limit coverage to work for or contract with the HMO. They generally will not cover out-of-network visits.

Exclusive Provider Organization (EPO)

An EPO is a managed care plan where services are only covered if you visit doctors/specialists within the network, except for an emergency. 

Point Of Service (POS)

A POS allows you to pay less when you use in-network providers. This option requires referrals for specialists.

Preferred Provider Organization (PPO)

With a PPO, you can also have lower costs for seeing doctors, hospitals, and specialists within the network. However, you can use out-of-network providers without a referral for an additional cost.

5 Tips For Selecting A Healthcare Plan

Here are My Healthcare Direct’s top tips:

Consider Your Healthcare Needs

Before researching health insurance policies, it’s important to make a list of what you’re looking for. For example, consider what costs you can afford, what kind of care you need, and the types of network plans that appeal to you. This will allow you to determine whether you need short-term, long-term, or supplemental insurance. 

Compare Plans

Every insurance policy has variations in premiums, deductibles, and what is covered. Comparing healthcare policies with online research allows you to understand the differences between them. It also helps you determine what is most appropriate for you. 

Select Network Type

Part of the selection process involves deciding which type of network you’re looking for (i.e., HMO, PPO, EPO). 

The Four Categories

Many marketplace plans have four categories, such as Bronze, Silver, Gold, and Platinum. Although the classifications have nothing to do with quality of care, they differ based on costs.

Learning about these classifications guides you to make an informed decision. 

Evaluate Total Costs

A major factor in choosing a policy depends on its expenses. It’s essential to be aware of your budget constraints and needs prior to comparing them and their costs. 

Ways To Apply For Coverage

There are several ways to apply for health insurance, including:

  • Online
  • By phone
  • With the help of someone in your community
  • Using certified enrollment partner websites or healthcare insurance professional agents
  • Paper application

How To Get A Health Insurance Plan

When you’re ready to get a marketplace policy, there are several steps to follow:

Create a marketplace account 

You can start an account by visiting my for assistance starting an account or contacting an insurance expert, such as through our agents at My Healthcare Direct

Gather all the paperwork and information you need to apply 

You can use this checklist or find other relevant information by visiting the provider’s website directly.

Fill out the application to find out your eligibility results

They will be sent to you after your application is processed. This will tell you if you qualify for tax credits, free, or low-cost policies.  

Finish enrollment

Once all the other steps are done, you can complete your application. 

Consult My Healthcare Direct  

If you’re having difficulty navigating the healthcare marketplace, don’t worry! We will assist you with finding the insurance that best suits you using My Healthcare Direct professional’s extensive knowledge and experience. More so, we cater to your healthcare needs and eliminate your stress! 

Please contact us today with any questions or to get started on your enrollment. 

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