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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.

BRONZE

BRONZE

SILVER

SILVER

GOLD

GOLD

PLATINUM

PLATINUM

General Questions

What are Essential Benefits?

Essential Health Benefits (EHB) must include items and services within the following 10 categories:

  • Ambulatory Patient Services
  • Hospitalization
  • 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?

Open enrollment begins November 1, 2019 and closes December 15, 2019.

When will my coverage begin?

Those who have enrolled in between November 1 and December 15, 2019 will have their coverage begin January 1, 2020.

Who can use the Marketplace?

To be eligible to enroll in health coverage through the Marketplace, you:

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?

Outside Open Enrollment, you can get health insurance only 2 ways:

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

MOVING

GETTING MARRIED

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.

Questions?

Call toll free: 866.454.4458

Rather talk in person? Call or stop into our office. We’re here to help.