The Health Insurance Marketplace will give Americans who are uninsured, or who buy their own coverage, a new way to shop for coverage.

Key Points of the Health Insurance Marketplace

Easier to shop and compare: For the first time, consumers will be able to go to one place to search for health coverage options; to get accurate information in easy-to-understand language on different plans; and to make apples-to-apples comparisons of private insurance plans. Consumers will be able to get comprehensive information about plan benefits, quality and price.

One application to qualify and enroll:
Consumers will only have to fill out one application to learn if they and their family members qualify for programs like Medicaid or the Children's Health Insurance Program, or to find out if they qualify for lower costs on monthly premiums or out-of-pocket costs on private plans. The single application will also allow consumers to enroll themselves and their family members into the plan(s) that best meet their needs, whether Medicaid, CHIP or private insurance.

Comprehensive benefits, consumer protections:
All health plans offered in the marketplace must cover a comprehensive set of benefits, discrimination against individuals with pre-existing conditions charging higher rates based on gender including physician visits, preventive care, hospital stays and prescriptions. Plans must also treat everyone fairly; discrimination against individuals with pre-existing conditions and charging higher rates based on gender will be banned.


How and where can consumers access the marketplace and get answers to their questions?

The North Carolina Department of Health and Human Services (DHHS) is preparing a toolkit for use by local Departments of Social Services and local health departments. The toolkit will provide information on how individuals can obtain medical assistance.  ARHS and the State DHHS encourage the public to visit www.healthcare.gov or call 1-800-318-2596 to obtain additional information about the federal Health Insurance Marketplace. 



Additional Information on marketplace access

There are three ways consumers can access the marketplace and get assistance: online, on the phone or in person. Consumers can submit their marketplace applications online, by mail, or in person.

  1. The official marketplace websites are www.Healthcare.gov and www.Cuidadodesalud.gov.

    Already, consumers can find answers to common questions and learn how the marketplace will work in their states.  Consumers can also chat online with marketplace representatives or sign up for email and text updates.  Starting October 1, they can find plan and pricing information and enroll for coverage.

  2. There is also a 24-hour toll-free marketplace consumer assistance number: 1-800-318-2596 (or 1-855-889-4325 TTY/TDD).

    Trained representatives can provide educational information prior to Oct. 1, and enrollment assistance after Oct. 1. Assistance is available in more than 150 languages.  Special assistance for small business owners is available at 1-800-706-7893, Monday through Friday, 9 a.m. to 5 p.m. EST.

  3. In-person assistance will also be available starting in October.

    Depending on whether a state is establishing its own marketplace, defaulting to the federal marketplace or partnering with the federal government to run a marketplace, assistance program options include navigators, non-navigator assistance personnel, certified application counselors, and agents and brokers. CMS created an overview of these assistance programs. Consumers and partners can find assistance locations near them at www.LocalHelp.healthcare.gov or www.AyudaLocal.cuidadodesalud.gov.    The database will be regularly updated to add new locations as they become available.


Can and should everyone use the marketplace? 
Who will qualify for lower costs?

Most people without employer or government-provided health insurance will be able to purchase coverage in the marketplace if they want to, and many will get help with costs. Based on income and access to other coverage, individuals and families may qualify for lower monthly premiums or out-of-pocket costs or for public programs such as Medicaid or CHIP.  The marketplace will be most important and useful for people who currently have few or no coverage options, such as individuals with pre-existing conditions or those who are self-employed, employed part time or unemployed.

Not everyone will need to use the marketplace, and some won't be eligible to participate. People who already have coverage through their employers or through Medicare probably won't need to use the marketplace, although someone paying high costs for employer coverage might want to explore their options in the marketplace. Some populations, including non-citizens and incarcerated people, will not be eligible to participate in the marketplace.


What do consumers need to know about the requirement to obtain coverage?

Starting in 2014, the ACA's minimum essential coverage provision (also known as the "individual mandate") will require U.S. citizens and legal residents to (1) obtain and maintain "minimum essential coverage" for themselves and their dependents, or (2) to pay a penalty, or (3) to opt out if they qualify for one of numerous exemptions. The site www.Healthcare.gov has information about the coverage requirement, including what qualifies as minimum essential coverage, the penalty and who is exempt from the requirement.


Important Dates to Remember

October 1, 2013:

  • The marketplace officially opens; consumers can start submitting applications and enrolling for coverage.

January 1, 2014:

  • Marketplace plan coverage begins as early as this date.
  • Medicaid expansions begin in many states.
  • New insurance protections begin, such as the ban on denying coverage based on pre-existing conditions.
  • Minimum essential coverage requirement begins.

March 31, 2014:

  • The first marketplace open enrollment period ends. After this date, consumers will not be able to get health coverage through the marketplace until the next annual enrollment period (in fall 2014, to enroll for coverage that will begin January 2015), unless they have a qualifying life event like a job loss, birth or divorce.

Official marketplace websites: www.Healthcare.gov  and www.Cuidadodesalud.gov  

  • Information and answers anytime
  • Compare plans and enroll starting Oct. 1
  • Coverage starts as early as Jan. 1, 2014

24-hour toll-free marketplace call center: 1-800-318-2596 (1-855-889-4325 TTY/TDD)

  • Information and answers anytime
  • Enrollment assistance starting Oct. 1
  • Assistance in 150+ languages

Helpful Links:


*Information on this page was compiled through resources provided by the American Public Health Association (APHA)