Eaton Agency has all the tools available for you to easily shop for health insurance plans in the marketplace. We help clients compare benefits, cost, and coverage and make the decision that’s best for their needs.
Some people who enroll through the marketplace will qualify for a tax credit that allows a lower monthly insurance payment. The tax credit is based on the income estimate and household information you put on the marketplace application.
The Open Enrollment period is:
- November 1 - January 15
There are special-enrollment periods that open when life circumstances change. These circumstances include changes such as moving, loss of a job, or the addition of a family member, as well as others. If you are unsure if you qualify for a special-enrollment period, our agents can help you determine your eligibility.
Marketplace health insurance plans are required to cover 10 essential health benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Additional benefits that must be included:
- Birth control coverage
- Breastfeeding coverage
Essential health benefits are minimum requirements for all marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:
- Dental coverage
- Vision coverage
- Medical management programs (for specific needs like weight management, back pain, and diabetes)
When comparing plans, you’ll see exactly what each plan offers. Our goal is to educate clients on the benefits and differences in plan levels so they can decide which coverage best fits their needs.
