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Choosing A Health Plan

Why should I buy health insurance?

There are many reasons why you should have health insurance. Health insurance provides you with financial security. No one plans to become sick or injured, but at one time or another we all need healthcare. When that happens, health insurance protects you from high, unexpected medical costs. Also, when you receive care from an in-network Learn More >>

How does health insurance work?

The more you know about health insurance, the better informed you will be when it is time to choose a plan that is best suited for you. At a high level, when you purchase health insurance, you, along with everyone else who has purchased the plan, have agreed to pay a fee in exchange for Learn More >>

What should I consider when choosing a plan?

When choosing a health plan there are a variety of factors that you should consider. Below is a brief discussion of each. When you are ready, please use our plan selection tool to help guide your decision-making. What is the difference between premiums and cost sharing? How do I know if I am eligible for Learn More >>

Should I consider my current health when choosing a plan?

You should consider how much care you think you may need during the year. While no one can predict each time they will get sick or injured, we generally have a pretty good idea of any conditions or health problems we have, how often we see a healthcare provider, and how many medications we take. Learn More >>

What types of plans are available?

All health insurance plans sold to individuals and small businesses must include certain benefits. These benefits are often referred to as the “essential health benefits.” This means that all plans, regardless of the level of coverage, will generally have the same benefits. There are, however, ways in which plans vary. For example, they might have Learn More >>

When can I purchase coverage?

Different types of coverage accept enrollment at different times. Click here to see what type of coverage you might be eligible for. Individual coverage: If you purchase coverage on your own through the individual market, open enrollment for the 2019 plan year begins on November 1, 2018, and ends December 15, 2018. Be sure to enroll early Learn More >>

Where can I get coverage?

If you are over the age of 65 If you are over the age of 65 you may be eligible for Medicare. Click here to learn more about determining your eligibility. If you are not over the age of 65 If you are under the age of 65 and employed full-time you may be able Learn More >>

What is a provider network?

Health insurance companies contract, or enter into agreements, with healthcare providers – doctors, specialists, and hospitals – to provide their members with quality care at a discounted rate. These providers are called “in-network providers.” Providers that don’t contract with the health insurance company are called “out-of-network” providers. Because the health insurance company has negotiated a Learn More >>

What type of plan and provider network should I choose?

Health insurance companies offer consumers different types of plans. Depending on the type of plan you buy, your care may be covered only if you see an in-network provider. Your plan may also require you to pay more or get a referral if you choose to receive care from a provider that is not part Learn More >>

Can I be denied coverage?

If you meet the requirements of the plan – you live in the service area, enroll during the open enrollment or special enrollment period, etc. – a health insurance company must offer a policy to any eligible applicant without regard to health status. This means a health insurance company cannot deny you coverage because of Learn More >>

How is the cost of my insurance determined?

There are many factors that will affect your cost of coverage, including: Where you live; The number and age of individuals included on your coverage; Whether or not any individuals on your policy use tobacco; Whether or not you qualify for any financial assistance; and The level and type of plan you select. To see Learn More >>

How does payment for health insurance work?

Insurance can be difficult to understand. To learn more about how it works, click here. Learn More >>

What is the difference between premiums and cost sharing?

The amount you pay each month for coverage is called your monthly premium. Your monthly premium will vary depending on your category of coverage, age, where you live, whether or not you use tobacco, and the provider network associated with the plan. Lower premium plans tend to require enrollees to pay more for the care Learn More >>

How do I know if I am eligible for premium tax credit or cost sharing reductions?

According to the Internal Revenue Service (IRS) if you earn less than $48,560 for an individual or $100,400 for a family of four, you may be eligible for a premium tax credit in 2019 to help you afford coverage. The income limits for financial assistance change with family size. For example, if you are a family Learn More >>

Is there a waiting period before my coverage becomes effective?

Possibly; it depends on the type of coverage you have. Individual Market Coverage: The effective date of coverage in the individual market is set by the open enrollment and special enrollment period rules but is generally after you submit an application. After submitting an application, you should receive an eligibility notice alerting you to choose Learn More >>

What are essential health benefits?

Under the Affordable Care Act (ACA) all health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, must offer a comprehensive package of items and services, known as the “essential health benefits.” The ACA stipulates that essential health benefits include items and services within at least Learn More >>

What benefits are included in a plan?

Under the Affordable Care Act (ACA), all health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, must offer a comprehensive package of items and services, known as the “essential health benefits.” This means that all plans, regardless of the level of coverage, will generally have Learn More >>

Which drug formularies are covered by my plan?

Under the Affordable Care Act, health insurance companies must provide coverage for prescription drugs in all health insurance plans sold to individuals and small businesses. The specific drugs covered will differ from plan to plan. If you take a specific medication(s), you may want to ensure that those medications are included on the formulary of Learn More >>

Changing Your Coverage During Open Enrollment

Each year, consumers who buy health insurance through the Marketplace can pick a new health insurance plan during the Open Enrollment period. If you are currently enrolled in a Marketplace health insurance plan, you can renew, update, or change your plan for 2019. Renew. If you like your current coverage, you can stay in your plan. Learn More >>

What is the difference between Marketplace coverage and short-term plans?

Marketplace plans offer comprehensive coverage. All Marketplace plans are required to cover certain categories of service, called Essential Health Benefits. Marketplace plans cannot have an annual or lifetime limit on essential health benefits. Remember that preventive services and immunizations are provided at no cost in all Marketplace plans. Also, under the law, in 2019, Marketplace plans cannot have an out-of-pocket maximum greater than $7,900 (or Learn More >>