Health Insurance Marketplace

You’ve heard a lot of buzz about healthcare reform and now you want to know how it will affect you and your family! We’ve got the answers on everything you need to know about what’s new in the health insurance market.

What is the Marketplace?

The Marketplace (many times referred to as the Exchange) is an online hub where individuals and families can compare different health insurance options available to them.

What are the advantages to purchasing insurance coverage on the Marketplace?

The Marketplace offers premium tax credits and cost sharing reductions to those that qualify, which are not available to plans purchased outside the Marketplace.  These benefits are only available to you when you purchase a plan through your state’s Marketplace. Even if you’re covered under a Sanford Health Plan, it’s important to remember that you need to update your information on annually (or as major changes arise) to keep receiving any appropriate tax credits or cost sharing reductions.

Who is Eligible for Premium Tax Credits?

Eligibility for the new tax credit is based on

  • Household income and family size for the year
  • Income between 100% to 400% of the Federal Poverty Level (FPL)
  • Ineligible for other health insurance coverage, such as through an employer or government-sponsored health plan


*This is not a comprehensive list, and more details can be found at
Who is Eligible for a Cost-Sharing Reduction?

Eligibility for reduced cost sharing is based on

  • Incomes between 100-250% of the Federal Poverty Level (FPL) based on family size. If your state has Expanded Medicaid Services, then incomes between 138-250% of the FPL can qualify.
  • Enrolling in a Marketplace silver-level plan
  • Members of Federally-recognized Indian Tribes

*This is not a comprehensive list, and more details can be found at

How do I get more information on the Marketplace?
Visit to find specific information on your state’s Marketplace option. 

The information provided above is for educational purposes only and not a substitute for professional advice. While Sanford Health Plan tries to keep the information as accurate as possible, health care information changes rapidly and thus this information should not be relied upon as comprehensive or error free. In no event will Sanford Health Plan be liable to you or anyone else for any decision made or action taken by you or anyone else in reliance upon the information contained on this page.

Marketplace Rate Increase Justification 

The Centers for Medicare & Medicaid Services (CMS) requires all Qualified Health Plans, including Sanford Health Plan, to post notification on its website explaining why rate increases are necessary for health plans offered on the health insurance marketplace.

Rate increase justifications for Sanford Health Plans marketplace plans can be found on by selecting your state, entering Sanford Health Plan and searching the desired date range.