Understanding the Health Insurance Marketplaces

The health care reform law says that each state must offer a Health Insurance Marketplace, sometimes referred to as a public exchange. These marketplaces will allow individuals and families to buy health insurance themselves instead of getting it through their employers.

Health Insurance Marketplaces will be available in each state and will be operated by the state, by the federal government, or through a partnership between the state and federal government.

How Does the Marketplace Work?

You will be able to enroll online or speak with a representative to help you find a health insurance plan that meets your needs. Each Marketplace will offer a range of plan choices, and each will provide its own set of benefits and have its own cost. But all the plans available through the Marketplace will have some benefits in common:

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Preventive care services, like routine check-ups and well-baby care visits will be covered at 100%—you pay nothing. No lifetime dollar maximums, or dollar caps, on essential health benefits. Those include hospitalization, outpatient services, maternity care, prescription drugs, emergency care, and preventive services. Limits on how much an individual pays out of pocket (such as a copay, coinsurance or deductible) in any given year.

In addition, the Health Insurance Marketplace can help you find out if you are eligible for financial assistance to pay for health insurance through the Marketplace. Assistance may be available to help pay your premiums and also to help limit your cost when you use your benefits. Assistance like this is called a subsidy. Eligibility for subsidies is, in part, based on your family’s household income. Please note that if you qualify for an “R”Us health plan, you will not be eligible for subsidies through the Marketplace. That’s because Toys“R”Us offers health plans that meet the health care reform law requirements for providing comprehensive and affordable coverage. If you do receive a subsidy while eligible for our plans, you may be required to pay it back to the government

There is more to come…

The Health Insurance Marketplace is there to help you find the best plan for you and your family. It can also help you determine if you are eligible for any subsidies or qualify for Medicaid. Open Enrollment through the Health Insurance Marketplace will begin November 1, 2015. Health insurance coverage purchased through the Marketplace will  start on January 1, 2016. You can find out more information about Health Insurance Marketplaces at www.healthcare.gov and information about “R”Us health plans on RUsBenefits.com.

What Does This Mean For Me?

It is up to you to have health insurance for yourself and any eligible dependents. Toys“R”Us is here to help by explaining the options available to you and the steps you need to take so that you’re covered.

If you are benefits eligible, you are eligible for health insurance through Toys“R”Us, but you are not eligible for subsidies from the government. As long as you are not receiving health insurance from another source, like your spouse’s/domestic partner’s or parent’s plan, we believe an “R”Us health plan may be your best option for coverage.

If you are not benefits-eligible, you are not eligible for health insurance through Toys“R”Us. You might be able to get health insurance through your spouse’s/ domestic partner’s or parent’s employer plan, an individual policy through the Health Insurance Marketplace in your state, an individual policy outside the Marketplace, Medicare or Medicaid, or another source. 

What Do I Need to Do?

Check to see if you qualify for financial assistance through the Health Insurance Marketplace.

Are you eligible for “R”Us benefits?

  • If you are, you do not qualify for financial assistance from the federal government through the Health Insurance Marketplace because you are eligible for the Toys“R”Us health plan, which provides comprehensive, affordable coverage. If you do receive a subsidy while eligible for our plans, you may be required to pay it back to the government
  • If you aren’t, the Health Insurance Marketplace in your state will help you see if you meet the requirements to qualify for financial assistance. You can find out more information about the marketplaces at www.healthcare.gov, the website sponsored by the Department of Health and Human Services.

Check to see if you qualify for Medicaid.

Check the Medicaid website in your state. State Medicaid contact information can be found at www.medicaid.gov.

  • If your household income is below the cut-off, you may qualify for Medicaid.
  • If your household income is more than the cut-off, you do not qualify for Medicaid.

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