Your Guide to Health Insurance Exchange

• Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
• Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
• Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
• Preferred Provider Organization (PPO): A type of ACA Health Plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

For information regarding eligibility requirements for ACA exchange plan availability and subsidies, you should refer to HealthCare.gov directly at this link.

For select states, there are additional financing options offered that may help offset the cost of your premium or lower your deductible/out-of-pocket costs. To see if your state offers these programs and if you are eligible, refer to your state specific marketplace using this link.

HealthCare.gov maintains a page that allows individuals to check based on their income if they qualify for marketplace subsidies, Medicaid, or the Children’s Health Insurance Program at this link.  

HealthCare.gov maintains a database of all plan options available to individuals based on their zip code. You can access this website by following this link.

For select states, there are individual website exchanges. If you reside in one of the following states, please click the state link to be redirected to that state’s enrollment website.

Northeast

• Connecticut — Access Health CT
• Maine — CoverME.gov
• Massachusetts — MA Health Connector
• Rhode Island — HealthSource RI
• Vermont — Vermont Health Connect

Mid-Atlantic

• District of Columbia — DC Health Link
• Maryland — Maryland Health Connection
• New Jersey — Get Covered New Jersey
• New York — NY State of Health
• Pennsylvania — Pennie
• Virginia — Virginia’s Insurance Marketplace

Midwest

• Illinois — Get Covered Illinois
• Kentucky — kynect
• Minnesota — MNsure

South

• Arkansas — My Arkansas Insurance
• Georgia — Georgia Access

West

• California — Covered California
• Colorado — Connect for Health Colorado
• Idaho — Your Health Idaho
• Nevada — Nevada Health Link
• New Mexico — beWellnm
• Oregon — Oregon Health Insurance Marketplace
• Washington — Washington Healthplanfinder

We know that these options can contain an overwhelming amount of information, that is why Rio Grande Valley maintains Certified Application Counselors at every hospital location to help individuals navigate the complexities of marketplace exchange plan enrollment. To schedule time with a counselor, please click the link below or call Monday through Friday from 9 a.m. CT to 8 p.m. CT toll-free at (956) 594-8156.

Rio Grande Valley has put together a list of plans from each carrier (available by state) that include Rio Grande Valley as an in-network provider for the 2027 ACA plan year. Our Rio Grande Valley healthcare network is in-network with most major health plans. For more assistance, please reach out to a certified application counselor at (956) 594-8156.

 

Individuals can enroll in a Health Insurance Marketplace plan through a variety of methods:

• Schedule time or request a callback with a certified application counselor at Rio Grande Valley.
• Utilize a non-profit that has received funding from the federal government, Healthcare.gov has compiled a non-exhaustive list of these non-profits at this link
• Utilize a government certified enrollment partner, Healthcare.gov has compiled a non-exhaustive list of brokers, agents, and assisters found here
• Enroll directly yourself by going to HealthCare.gov through this link

For select states, enrollment must happen on a state specific website. If you reside in one of the following states, please click the state link to be redirected to that state’s enrollment website.

Northeast

• Connecticut — Access Health CT
• Maine — CoverME.gov
• Massachusetts — MA Health Connector
• Rhode Island — HealthSource RI
• Vermont — Vermont Health Connect

Mid-Atlantic

• District of Columbia — DC Health Link
• Maryland — Maryland Health Connection
• New Jersey — Get Covered New Jersey
• New York — NY State of Health
• Pennsylvania — Pennie
• Virginia — Virginia’s Insurance Marketplace

Midwest

• Illinois — Get Covered Illinois
• Kentucky — kynect
• Minnesota — MNsure

South

• Arkansas — My Arkansas Insurance
• Georgia — Georgia Access

West

• California — Covered California
• Colorado — Connect for Health Colorado
• Idaho — Your Health Idaho
• Nevada — Nevada Health Link
• New Mexico — beWellnm
• Oregon — Oregon Health Insurance Marketplace
• Washington — Washington Healthplanfinder

Broadly, you will need:

• Basic information about yourself (including your name and date of birth)

• Basic information about your household (including spouses, children, and anybody claimed on your tax return as a dependent)

• Home and/or mailing addresses for everyone applying for coverage

• A Social Security Number (SSN) for each person included in your application

• Employer and income information for everyone in your household—including a best estimate of your household income

• Current health insurance information

• [If applicable] Immigration document information for each lawfully present immigrant

• [If applicable] Current health coverage information

• [If applicable] Health Reimbursement Information (HRA) notice through your employer

  Healthcare.gov has put together a helpful checklist to help individuals know what information they need to apply for or re-enroll in marketplace insurance coverage. You can find that checklist by clicking here.

In most cases, you can only enroll in health insurance during a specific period called Open Enrollment. This typically runs from November 1 to January 15. If you don't sign up during this window, you may need to wait until the next Open Enrollment period before you can get coverage. There are some exceptions. If you experience a qualifying life event - such as getting married, having a baby, or starting a new job - you may be eligible to enroll outside of Open Enrollment. However, it's important to note that verification for these exceptions has become stricter. You'll likely need to provide official documentation (such as a marriage certificate, birth certificate, or employment verification) to confirm your eligibility before your coverage can begin.

The federal tax penalty was eliminated effective Jan. 1, 2019. That means you won’t have to pay a federal tax penalty if you fail to enroll in minimum essential coverage for major medical insurance. Several states, including California, the District of Columbia, Massachusetts, New Jersey, and Rhode Island, have implemented individual mandates that impose state tax penalties on residents who do not have health insurance.

Choosing health insurance coverage can feel overwhelming, and it's easy to focus on the monthly premium rather than the big picture. To find the best health insurance plan for you, start by considering your healthcare needs and budget for the year to come. Also, be sure to consider what your healthcare expenses were in the past year and if your current coverage was adequate. Did anything change, or do you expect it to change in the coming year? To schedule time directly with a certified application counselor who can help you navigate the enrollment process or request a callback please click here. You may also call toll-free at (956) 594-8156 from Monday through Friday from 8 a.m. CT to 6 p.m. CT to chat live with one of our certified application counselors.