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5 Steps to Navigate the Health Care Marketplaces

Updated for Tax Year 2020


OVERVIEW

To navigate the Health Insurance Marketplace, you have to know what you want from a health plan. Have your previous plan handy to make comparisons, as well as household and income information. If this is your first health plan, be aware of your needs and know your tax situation. Eligibility depends on the size of your family and combined income from all sources.


Marketplace basics

No one is required to use the Marketplace to purchase a health plan, but it does provide a wide range of options to suit a variety of needs and budgets. Some of its advantages include:

  • The Marketplace is administered by the Department of Health and Human Services.
  • The start of your health care coverage depends on when you enroll.
  • Filling out an application on the Marketplace site allows you to compare costs and options of various plans.
  • To be eligible for any tax credit, you must purchase health insurance through the Marketplace.

how to navigate healthcare marketplaces

Qualifying health coverage

The Affordable Care Act requires you to have qualifying health insurance coverage, or through 2018, make an individual shared responsibility payment when you file your tax return. After 2018, individual shared responsibility payments are not required. If you currently have coverage but are looking to compare plans and costs, have the policy handy when you navigate the Marketplace. Other government-approved health insurance options include:

  • A health plan obtained from an insurance company;
  • Government health plans such as veteran's programs, Medicare, Medicaid;
  • An employer-sponsored plan, including retiree insurance and healthcare continuation under the Consolidated Omnibus Budget Reconciliation Act.

What to include on the application

The Marketplace application requires some basic information to provide appropriate plans to suit your health needs and budget. Include yourself, your spouse or unmarried partner and any other person you claim as a dependent or take care of. Dependents can live with you or at another address. Also add your children who reside with you, even if they file their own tax return. Family and household information is used to determine eligibility for lower-cost insurance plans.

What to leave out

Leave out information on your unmarried partner if that person doesn't require health insurance. Any children belonging to your unmarried partner, unless they are your dependents, are not included. Parents and relatives who live with you but are not considered dependents should be excluded as well. Don't consider any financial information such as child support income, supplemental security income, gifts, workers' compensation, veteran's disability payments and loans, including bank loans, student loans and home equity loans.

Estimate your income

To determine Marketplace coverage, you need to estimate your 2020 income.

"Your income determines any tax credits you may be eligible for, such as the premium tax credit that can help with the cost of your insurance," advises Bill Symons, president of Computer Accounting Systems in Oswego, N.Y. "Be sure to include any and all sources of income you receive. And, add the total income from your spouse if you file jointly, along with your dependents who earn enough to file a return."

Estimate all income, including wages, tips, net income from self-employment, alimony payments, unemployment income, pension, awards, investments, retirement income, Social Security and disability payments.

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