Frequently Asked Questions
Navigating the Insurance Marketplace can be difficult and sometimes overwhelming. Below, in our frequently-asked-questions, you’ll find information to help choose the right plan. Of course, our staff is ready to assist you – call or walk into our local office and speak to your health care advocate anytime.
LEVELS OF COVERAGE FOR AFFORDABLE CARE ACT PLANS
The Marketplace has health insurance plans categorized into four different groups, according to how much the plan will pay (on average) for the average person. The plan will pay 60-90% of the average cost of all Essential Health Benefits for an average person.
What are Essential Benefits?
- Ambulatory Patient Services
- Mental Health & Substance Use Disorder Services, Including Behavioral Health Treatment
- Rehabilitative & Habilitative Services & Devices
- Laboratory Services
- Emergency Services
- Maternity & Newborn Care
- Prescription Drugs
- Preventative Wellness Services & Chronic Disease Management
- Pediatric Services (pediatric oral care may be included or offered as part of a stand-alone dental plan)
When is open enrollment?
When will my coverage begin?
Who can use the Marketplace?
- Must live in the United States.
- Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses.
- Can’t be incarcerated.
If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan. Learn more about Medicare and the Marketplace.
Can I get coverage outside of the open enrollment period?
- The Special Enrollment Period: You can qualify if you lose job-based coverage, have a baby, get married, or have certain other life changes.
- Medicaid or the Children’s Health Insurance Program (CHIP): You can apply any time and can enroll immediately if you’re eligible.
SPECIAL ENROLLMENT EXCEPTIONS
Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including:
LOSS OF HEALTH COVERAGE
HAVING A BABY
ADOPTING A BABY
If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply. For more information and specifics and to see if you qualify for a Special Enrollment Period, click on the link below.
Call toll free: 866.454.4458
Rather talk in person? Call or stop into our office. We’re here to help.