The Federally-Facilitated Marketplace (FFM) is an online option to buy health insurance for individuals and for small businesses that provide insurance for their employees to purchase coverage. Through the FFM, individuals and small businesses can compare health plans, get answers to questions, determine eligibility for lower out-of-pocket costs and enroll in health plans. Visit HealthCare.gov for more information.
Insurance plans in the FFM are offered by private insurance companies, as are plans offered in the Private Market. If you are eligible for federal tax subsidies under the ACA, they will be available to you when you purchase health insurance through the FFM.
Open enrollment for the FFM is from November 15, 2014 until February 15, 2015. Visit HealthCare.gov to learn more.
Will individuals and small businesses be required to use the FFM?
No. Individuals and small businesses may use either the FFM or Pennsylvania’s Private Market. However, to access premium subsidies available to qualified individuals (household incomes below $94,200 for a family of four, or below $45,960 for an individual) and cost-sharing reductions for individuals (household incomes below $58,875 for a family of four, or below $28,725 for an individual), or for small businesses to access tax credits that may be available, you will need to purchase through the FFM.
What plans are available?
All plans offered in the individual and small group markets offer the same core set of benefits called Essential Health Benefits (like doctor’s visits, prescriptions, hospitalizations, pregnancy and more). This will allow consumers to compare plans on an "apples to apples" basis. Plans offered through the FFM, like plans offered in the Private Market, may also include additional benefits. All plans offered in Pennsylvania’s individual and small group markets are approved for sale by the Pennsylvania Insurance Department, and plans offered through the FFM are certified by the federal government as Qualified Health Plans (QHPs), meaning that they will meet certain federal standards.
To help you understand the value of a plan, a plan is identified by how much of your possible health care costs the plan will be expected to cover. The category you choose affects how much your premium costs each month and what portion of the bill you will pay out-of-pocket for things like hospital visits or prescriptions. The categories do not reflect the quality or amount of care the plans provide.
The four levels are:
Bronze (lowest monthly premium, highest out-of-pocket expenses);
Silver (standard monthly premium and out-of-pocket expenses);
Gold (higher monthly premium, lower out-of-pocket expenses);
Platinum (highest monthly premium, lowest out-of-pocket expenses).
How can I compare benefits and understand what is covered by a plan?
Insurance companies must provide consumers with a Summary of Benefits and Coverage (SBC) and a glossary of commonly used terms before enrollment or renewal. An SBC is designed to help consumers compare plans and understand the benefits and coverage limits of their plan in clear and concise language.
Using the SBC, consumers can compare insurance options based on covered benefits, excluded services, deductibles and out-of-pocket costs, as well as other features that may be important to them, such as whether a specific doctor participates in the provider network. While the SBC provides examples, exact pricing and out-of-pocket costs will depend on the specific plan chosen and the provider delivering the services.
Visit HealthCare.gov to learn more.
Can I enroll through the Federally-Facilitated Marketplace now?
Yes. Open enrollment through the FFM is November 15, 2014 through February 15, 2015. If you miss open enrollment, unless you have a special circumstance, you’ll very likely have to wait to apply until November 2015 to enroll in health insurance through the FFM. However, health insurance may be available to you in Pennsylvania’s private health insurance market outside of the FFM.
Visit HealthCare.gov to learn more, or to sign up for email or text alerts or to find out what you may qualify for through the FFM.
What can I do now?
Start by learning about different types of health insurance and understanding your needs.
Make a list of questions before it’s time to choose. For example, “Can I stay with my current doctor?”
Understand how cost-sharing, deductibles, co-payments and out-of-pocket maximums work.
Gather information about your household income, like your W-2, current pay stub or tax return.
Set your budget. Determine how much you can afford per month. Be sure to include premiums as well as cost sharing.
Talk with your employer to see if it offers health care coverage. If your employer does not offer coverage, or you cannot afford the coverage it does offer, you can apply through the FFM or private market.
How do I enroll?
You may enroll for coverage through the FFM between November 15, 2014 and February 15, 2015. During that time, you can submit an application online, over the phone or by mail. You may be eligible for a special enrollment period after the open enrollment period if your circumstances change. The next open enrollment period, for coverage beginning in 2016 will begin in November 2015.
The FFM application can help to determine your eligibility for multiple programs including premium assistance for insurance coverage and government-sponsored health care programs (like the Children’s Health Insurance Program (CHIP) or Medical Assistance).
You may also apply online for CHIP or Medical Assistance at anytime -- not just during open enrollment. Or, visit HealthCare.gov.
Finally, you may talk to a licensed insurance agent/broker or a licensed health insurance company to purchase insurance either through the private market or the FFM.
Application checklist for the FFM:
When applying, you’ll need to complete an application with basic information about you and your family, including:
Health insurance status; and
If you are applying for individual or family coverage, you’ll need:
Social Security Numbers (or document numbers for legal immigrants);
Employer and income information for every member of your household who needs coverage (pay stubs, W-2 forms, wage and tax statements); and
Policy numbers for any current health insurance plans covering members of your household.
If you are currently enrolled in Medicare, you do not need to buy additional health insurance. However, you should check your coverage annually to ensure it meets your needs. Medicare is not offered through the FFM. For more information, visit Medicare.gov.
If you are currently enrolled in TRICARE or the Veteran’s healthcare program, you do not need to make any changes. TRICARE is not offered through the FFM. If you are an active duty service member or retiree and you do not have health insurance, you may purchase insurance through the FFM.
The FFM does not offer COBRA health insurance at this time. However, you can use the FFM to look for more affordable options. If you choose to enroll in another health plan through the FFM, your COBRA coverage may not overlap your new coverage.
If you are applying for small group coverage, you’ll need a completed Employer Coverage Tool.
Where do I go for help applying?
In Pennsylvania, you have the option of contacting any of the following resources:
Health Insurance companies and licensed agents and brokers (producers): for purchasing coverage through either the private market or the FFM.
Navigators or Certified Application Counselors: for general information and for assistance in enrolling through the FFM.
Who can answer my questions about the FFM?
Visit HealthCare.gov for answers to many of your questions. Live web chat assistance is also available on the website. Or, call the FFM Call Center at 1-800-318-2596, 24 hours a day, 7 days a week (TTY/TDD 1-888-871-6594).
FFM customer service representatives can help you with questions about the FFM and plans offered through the FFM, including:
Small business questions
Licensed insurance agents and brokers can help you purchase insurance through the Private Market or the FFM, and can also assist with these types of questions.