Health insurance can be affordable. For some, government subsidies offset the cost of insurance. Others may be eligible for Medicaid when previously they were not. Avoiding penalties for not having insurance should be a factor too. Most importantly, health insurance provides peace of mind.
The Marketplace
The Heath Care Law
According to the Affordable Care Act, everyone who legally lives in the United States must have health insurance. For millions of uninsured people, this law gives access to healthcare plans at different cost levels. Based on their income and family size, those who qualify also may receive financial assistance when purchasing these plans.
What Will the Plans Cover?
All plans include coverage for doctor visits, hospital stays, wellness care, prescriptions, emergency services and more. In fact, there are 10 essential health benefits that are included in every plan, and certain preventive care services will be provided at no additional cost to patients. Insurers cannot deny coverage because of pre-existing conditions.
Open Enrollment is November 1 through December 15
If you do not have health insurance, you must sign up for 2017 coverage during open enrollment, from November 1, 2017 to December 15, 2017. You can shop for plans by phone, through a broker or at the online Marketplace, where you can compare benefits and costs easily. Those who do not sign up will face tax penalties.
If you currently have “charity care,” you should sign up for health coverage. With health insurance, you will be covered for things like doctors’ visits and prescription medicines, which are not covered now—and may not be covered when your charity care coverage ends.
Visit Healthcare.gov for additional information.
You can compare plans side by side, in simple language, and there’s no fine print. You can choose between four levels of health plans—Platinum, Gold, Silver and Bronze—from a variety of approved insurance providers. Each offers different amounts of coverage and different monthly premiums. Only one simple application is required.
Insurance Renewal
Renewing Your Marketplace Health Insurance Plan
The Open Enrollment Period is when individuals can purchase health insurance plans. If you already have health insurance, it is the time for you to shop for new Marketplace coverage or decide to stay in the same, or a similar, plan. The Marketplace Open Enrollment Period is from November 1, 2017 through December 15, 2017.
Your health insurance company will send you a letter by November 1, 2017 to let you know if your plan is still being offered and how the plan is changing.
- If your health insurance company will offer a plan in your area for 2018: The letter you get from your health insurance company will tell you the new monthly premium amount and any changes to the plan. If you have questions about plan benefits, which providers are in-network, or how to pay your premiums, call your health insurance company directly.
- If your health insurance company won’t offer a plan in your area for 2018: Your health insurance company may decide to stop offering certain plans next year. If your health insurance company won’t offer a plan in your area for 2018, then you’ll need to choose a new plan for 2018 to continue having coverage.
Be sure to go to
HealthCare.gov to make sure your current plan is still right for you. Be sure that the plan works for you—for example, that the doctors and hospitals you use, and prescription drugs you need, are still in-network. In most cases, if you do not take action, your health insurance company will automatically enroll you in the plan you currently have or the one most similar to it if your plan is no longer available. From November 1, 2017 to December 15, 2017, you can:
- Update your application information.
- See if you qualify for new or different help paying for your premiums and out-of-pocket costs.
- Compare available plans.
- Enroll in a plan that meets your needs.
Remember, you must enroll in a plan by December 15, 2017 for coverage in your new plan to start on January 1, 2018.
Financial Assistance
A surprisingly large number of people qualify for financial help when buying health insurance through the Marketplace. For example, someone who earns up to $47,520 a year, or a family of four earning up to $97,200 a year, qualifies for reduced monthly premiums or a tax credit at the end of the year.
By using one of several calculators that are available, you can estimate how much assistance you may obtain before you even visit the Marketplace site (www.HealthCare.gov). However, only the Marketplace will let you know the exact assistance you can expect.
Get Covered USA Calculator
Kaiser Family Foundation Calculator
Financial Assistance Income Chart
Look for your income and household size on this chart to see whether you qualify for financial assistance when purchasing health insurance.
| Household size |
100% |
133% |
150% |
200% |
300% |
400% |
| 1 |
$11,880 |
$15,800 |
$17,820 |
$23,760 |
$35,640 |
$47,520 |
| 2 |
$16,020 |
$21,307 |
$24,030 |
$32,040 |
$48,060 |
$64,080 |
| 3 |
$20,160 |
$26,813 |
$30,240 |
$40,320 |
$60,480 |
$80,640 |
| 4 |
$24,300 |
$32,319 |
$36,450 |
$48,600 |
$72,900 |
$97,200 |
| 5 |
$28,440 |
$37,825 |
$42,660 |
$56,880 |
$85,320 |
$113,760 |
Preventive Care Services
All marketplace plans must cover the following list of preventive services without charging you additional fees (copayment or coinsurance), even if you haven’t paid your yearly deductible. However, you must receive these services from a healthcare provider in your network. Screenings are also available based on certain criteria and conditions.
Preventive Screenings for All Adults
- Abdominal aortic aneurysm one-time screening
- Alcohol misuse screening and counseling
- Aspirin use
- Blood pressure screening
- Cholesterol screening
- Colorectal cancer screening
- Depression screening
- Diabetes (Type 2) screening
- Diet counseling
- HIV screening
- Vaccines and immunizations
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling
- Syphilis screening
- Tobacco use screening
Preventive Screenings for Women
- Anemia screening
- Breast cancer genetic test counseling (BRCA)
- Breast cancer mammography screenings
- Breast cancer chemoprevention counseling
- Breastfeeding comprehensive support and counseling
- Cervical cancer screening
- Chlamydia infection screening
- Contraception
- Domestic and interpersonal violence screening and counseling
- Folic acid supplements
- Gestational diabetes screening
- Gonorrhea screening
- Hepatitis B screening
- HIV screening and counseling
- Human papillomavirus (HPV) test
- Osteoporosis screening
- Rh incompatibility screening
- Sexually transmitted infection (STI) counseling
- Syphilis screening
- Tobacco use screening and interventions
- Urinary tract or other infection screening
- Well-woman visits
Preventive Screenings for Children
- Alcohol and drug use assessments for adolescents
- Autism screening
- Behavioral assessments
- Blood pressure screening
- Cervical dysplasia screening
- Depression screening
- Developmental screening
- Dyslipidemia screening
- Fluoride chemoprevention supplements
- Gonorrhea-preventive medication
- Hearing screening
- Height, weight and body mass index measurements
- Hematocrit or hemoglobin screening
- Hemoglobinopathies or sickle cell screening
- HIV screening
- Hypothyroidism screening
- Immunization vaccines
- Iron supplements
- Lead screening
- Medical history
- Obesity screening and counseling
- Oral health risk assessment
- Phenylketonuria (PKU) screening
- Sexually transmitted infection (STI) prevention counseling and screening
- Tuberculin testing
- Vision screening
10 Essential Health Benefits
All private health insurance plans on the Health Insurance Marketplace provide the same essential health benefits.
These are minimum requirements, but plans may offer additional coverage. Compare plans side-by-side on the Marketplace to see exactly what each offers.
Essential Health Benefits
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Source:
www.healthcare.gov/coverage/what-marketplace-plans-cover
