In Most States, Policies Will be Sold Outside The Health Law Marketplace

Insuring Your Health columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1.

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Q: Do I have to buy through the marketplace or can I get my insurance on the private market?

A: If you have good coverage available to you, either through your job, Medicare or Medicaid, you probably won’t need to shop for coverage through a marketplace. If you don’t have such coverage though, in most states you’ll be able to look for coverage either through the marketplace or on the private market next year. The District of Columbia and Vermont are the only exceptions; all of their individual and small-group policies will be sold through the exchanges.

In other states, new individual and small-group plans sold on the exchanges or in the private market must all cover the same package of 10 essential health benefits and conform to the same cost-sharing standards. But premium tax credits and cost-sharing subsidies that will make coverage more affordable will only be available for plans purchased through the marketplaces. That’s worth keeping in mind.

If you make more than 400 percent of the federal poverty level-about $46,000 for an individual or $94,000 for a family of four, you won’t be eligible for subsidies on the exchanges and may want to shop there and in the private market. If you’re currently insured and you want to hang onto the plan you have, you can do that on the private market as well.

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