FAQ: Buying Health Insurance Through the Health Insurance Marketplace

Health insurance marketplaces, or health insurance exchanges, serve as online markets where individuals can compare policies and buy insurance. Some states, like Massachusetts, have their own state-based marketplaces, while others are using the federally managed marketplace.

You may only purchase plans that are available in the state where you are a legal resident. Each state has its own residency definition and requirements. For example, to use the Massachusetts Health Connector, you must meet these residency requirements.

Regardless of how your state's health insurance marketplace is managed, you may begin by visiting healthcare.gov. From there, you'll be directed to the correct marketplace for your state of residency.

It is important to look beyond the cost of the premium. A low premium may save you money in the short term, but it could cost more in the long run. Plans with a low premium often have a high deductible (the amount you have to pay out of pocket before the insurance company will cover any remaining costs). Low-premium plans often have high copays as well.

You should compare any marketplace plan you are considering to the MIT plans available to students and affiliates. Keep in mind that the MIT plans have no deductibles for in-network services and low copays. You may also use your MIT coverage to get healthcare services throughout the United States using the local Blue Cross PPO network.

Besides considering out-of-pocket costs, you should ask:

• How does the plan handle referrals and authorizations? Does the plan require administrative pre-requirements, pre-certifications, or physician referrals that may force you to delay necessary care? MIT Medical does not participate with outside insurance plans and cannot provide students or affiliates with referrals or authorizations for services outside of MIT Medical. (Most services within MIT Medical are covered by tuition.)
• Can I find a healthcare provider easily and conveniently? Where are the plan's providers located? Are they accepting new patients? Many marketplace plans have limited provider networks. If you are outside the plan's geographic area, it may not cover medical care beyond emergency services. For example, a plan purchased in Massachusetts may not cover you when you go home for the summer, do an out-of-state internship, or study abroad. And a plan purchased in your home state may not cover you while you are at MIT.

You may be able to purchase a plan through the Marketplace, but you will not be eligible for a subsidy. And remember that any plan you purchase will not only need to satisfy state and federal requirements, it will also need to satisfy U.S. State Department requirements. Other informational resources exist on MIT's International Students Office page, and the MIT International Scholars Office site.

Marketplace insurance plans are classified into five categories: Bronze, Silver, Gold, Platinum, and Catastrophic. You may waive MIT SHIP coverage with a Silver, Gold, or Platinum plan. You may not waive with a Bronze or Catastrophic plan, because the potential out-of-pocket costs of those plans are unacceptable to MIT.

You may be eligible for a subsidy if you enroll in a plan through the health insurance marketplace. This subsidy calculator, created by the Henry J. Kaiser Family Foundation, can help you estimate your subsidy amount. But be careful when estimating your income; if you underestimate your income when purchasing a plan, you may be required to pay back any subsidies you receive. We strongly suggest discussing your situation with a licensed tax professional before assuming you are eligible for a subsidy.