Health Insurance Blog -
Understanding regular vs. emergency health care
Thu, 21 May 2020 00:00:00 -0400

It’s almost always best to get routine care and recommended preventive services from a primary care provider. There are big differences between visits to your primary care provider and emergency care.

Image: Primary care vs. emergency care

When to see your primary care provider

  • You’ll see your primary care provider both when you’re sick and when you’re well for regular care. They’ll get to know you and help track your health over time.
  • You can get primary care providers in doctors’ offices, clinics, and health centers nationwide.
  • Before you schedule your first appointment, contact your health plan to see how much you’ll have to pay for a primary care visit. The copayment for your visit may cost you between $0 and $50.

When to seek emergency care

  • You should go to the emergency room only when you’re injured or very sick. You may wait several hours before you’re seen, and you’ll likely pay a larger copayment, co-insurance and have to meet your deductible before your health plan helps pay your costs.
  • Providers in the emergency room probably won’t have access to your health records.
  • Always in a life-threatening or emergency situation, call 9-1-1.

See other differences between regular and emergency care.

Marketplace coverage & prescriptions: What you need to know
Thu, 07 May 2020 00:00:00 -0400

All Marketplace plans cover prescription drugs. Fill any prescriptions you got from your doctor and take them as directed. Here are 3 things to know about filling prescriptions:

Image: 3 things to know about filling drugs

  • You may have a prescription copayment. A copayment is the amount you owe for each prescription you fill. Copayments are usually between $0 and $50, depending on your insurance plan.
  • Check with your insurance company to see if you need preauthorization (also called “prior approval”). Your health plan may require preauthorization for certain drugs, unless it’s an emergency.
  • Different health plans allow you to get your medications from different pharmacies (called “in-network pharmacies”). Call your insurer, or visit their website to find out which pharmacies are in their network.

Get more information on prescriptions and what to do when your drug isn’t covered.

Sending documents to confirm Special Enrollment Period eligibility
Thu, 23 Apr 2020 00:00:00 -0400

If you applied for 2020 Marketplace coverage through a Special Enrollment Period, you may be asked to provide documents to confirm the life events that make you eligible. You must send them before you can start using your coverage.

Image: {How to confirm Special Enrollment Period eligibility}

You’ll learn if you have to provide documents after you submit your application. It’s best to pick a plan first and submit your documents afterwards. After you pick a plan, you usually have 30 days to send the documents.

Documents & deadlines for your life event

  • The documents you can submit vary based on your life event.
  • Select your life event for the documents you can submit and key dates.

How to submit documents

  • Provide the required documents as soon as possible after you pick a plan.
  • Doing so will prevent a delay in your coverage starting.
  • You can submit them online or copies by mail. Follow these steps.
  • After you submit them, you’ll get a letter or notice in your account within a couple of weeks saying if your Special Enrollment Period has been confirmed.

Learn more about when the Marketplace needs documents to confirm a Special Enrollment Period.

Simple ways to use Marketplace coverage to improve your health
Thu, 09 Apr 2020 00:00:00 -0400

Now that you have Marketplace health coverage, learn what you can do to stay healthy and get the care you need:

Image: {Tips for staying healthy and getting proper care}

Tips for staying healthy

  • Make time for physical activity, healthy eating, relaxation, and sleep.
  • Get the preventive services that are right for you.
  • Don’t forget to schedule follow-up visits. Ask your provider to notify you in advance when recommended health screenings should occur.
  • If you have questions or concerns between visits, just call your provider. It’s their job to help answer questions you have about your health.

Tips for getting proper care

  • You can get health care many different places, including the emergency department. But it’s best to get routine care and recommended preventive services from a primary care provider. They’ll work with you to ensure you get the right services, manage chronic conditions, and improve your general health and well-being.
  • Generally, you can find primary care providers in offices, clinics, and health centers.
  • Not all types of providers and facilities take all insurance plans or types of coverage. Before you make an appointment, call the office to make sure they accept your coverage.

Read the From Coverage to Care: Roadmap to Better Care and a Healthier You (PDF, 698 KB) for tips and information on putting your health first, knowing where to go for care, and preparing for appointments.

5 things to know about tax Form 1095-A
Thu, 12 Mar 2020 00:00:00 -0400

If anyone in your household had Marketplace health insurance in 2019, you should have already received Form 1095-A, Health Insurance Marketplace Statement, in the mail. Here are 5 important things to know about this form.

Image: {Helpful tips about tax Form 1095-A}

Helpful tips about tax Form 1095-A:

  • You should already have Form 1095-A. It comes from the Marketplace, not the IRS. If your form didn’t come by mail or you can’t find it, check your online Marketplace account before contacting the Marketplace Call Center.
  • Store it in a safe space with other important tax information, like W-2 forms. This way, you can easily find it when you sit down to file.
  • Before doing anything with the form, make sure it’s accurate. Check basic coverage and household member information, and confirm the premium for your second lowest cost Silver plan (SLCSP). Contact the Marketplace Call Center to report any errors.
  • If you request a new, updated form, it’s important that you don’t file until we send you the correct version. If you already filed, you may need to file an amended return using the information from your new 1095-A.
  • You’ll use the information from your 1095-A to “reconcile” your premium tax credit. To do this, you’ll compare the amount of premium tax credit you used in advance during the year against the premium tax credit you actually qualify for based on your final income for the year. Any difference will affect your refund or tax owed. See a step-by-step guide to “reconciling” your premium tax credit.
3 things to know about coronavirus disease and your Marketplace coverage
Fri, 06 Mar 2020 00:00:00 -0500

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You may be hearing about the coronavirus (officially called 2019-novel coronavirus or COVID-19) in the news. Currently, the rules in your Marketplace health plan for treatment for COVID-19, remain the same as for the treatment of any other viral infection. Check with your health insurance company for their specific benefits and coverage policy. Here are some other things to know about how your Marketplace health plan works when it comes to coronavirus:

Image: {3 things to know about coronavirus disease and your Marketplace coverage}

Understanding your coverage

  • Lab and other services: Individual and small group market issuers are generally required to include laboratory services as a category of Essential Health Benefits. Coverage for a specific diagnostic or laboratory service can vary by plan, so check with your health insurance company about their coverage for lab tests and related services for diagnosis and treatment of COVID-19. This is also true for your health plan’s coverage for physician and hospital services related to the diagnosis and treatment of COVID-19.
  • Telehealth: Telehealth services or home health visits may already be covered by many health insurance companies. You should check with your health insurance company to determine whether these services are covered and what you’ll pay.
  • Enrolling in coverage: If you aren’t currently enrolled in coverage, you can see if you qualify for a Special Enrollment Period. As a reminder, federal law and regulations provide protections against pre-existing condition exclusions in health insurance coverage. If you are eligible, health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Marketplace plans can’t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19.

For more information about the Coronavirus, please visit:

Tips for “reconciling” your premium tax credit on 2019 taxes
Thu, 27 Feb 2020 00:00:00 -0500

You have until April 15, 2020 to file your 2019 federal income tax return. If you had a Marketplace plan in 2019 and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you’ll have to "reconcile" your tax return.

Image: {How to "reconcile" your premium tax credit}

Through “reconciling,” you’ll find out if there's any difference between the premium tax credit you used and the amount you qualify for. Any difference between the two figures will affect your refund or tax owed.

How to "reconcile" your premium tax credit on 2019 taxes:

  1. Find your Form 1095-A, and verify its accuracy. If you didn’t get one, check your online Marketplace account. If it’s not there, try the Call Center. See how to be sure the information is correct.
  2. Print Form 8962 (PDF, 112 KB) and instructions (PDF, 356 KB).
  3. Use the information from your 1095-A form to complete Part II of Form 8962. Refer to this table as a guide.

Get more information on 2019 health coverage and your federal taxes.

Recent life change? You may qualify for a Special Enrollment Period
Thu, 13 Feb 2020 00:00:00 -0500

Now that Open Enrollment is over, you can enroll in or change Marketplace coverage only if you have a life event, like getting married, having a baby, or losing health coverage, that qualifies you for a Special Enrollment Period.

What are the qualifying life events for Special Enrollment Period eligibility?

Does my life event make me eligible for a Special Enrollment Period?

There are 4 basic types of qualifying life events:

  • Loss of health coverage: Losing job-based coverage (whether through yourself or a family member) or eligibility for Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP)
  • Household changes: Marriage, child birth or adoption, divorce, or death
  • Residence changes: Certain household moves, like moving to a new ZIP code or county
  • Other qualifying events (like income changes): Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP), leaving incarceration, etc.

See the full list of life events.

How do I apply for 2020 coverage through a Special Enrollment Period?

  • If you qualify for a Special Enrollment Period, create an account or log into an existing one to enroll in a plan for 2020.
  • You may be asked to submit documents to confirm the life event that makes you eligible.

Not sure your life event counts as a Special Enrollment Period? Just answer a few quick questions to find out.

3 routine ways to use your 2020 Marketplace coverage
Thu, 30 Jan 2020 00:00:00 -0500

Health coverage pays for provider services, prescriptions, hospital care, and special equipment when you're sick. It's also important when you're not sick. Now that you're enrolled in a health plan for 2020, here's how you can use your new coverage throughout the year no matter your situation.

Woman holding sign that reads "Tips"

Understanding & using your new coverage

  • Preventive health: Most coverage includes immunizations for children and adults, annual visits for women and seniors, obesity screening and counseling for people of all ages, and more for free.
  • Prescriptions: Health plans will help pay the cost of certain prescriptions. You may be able to buy other medications, but those on your plan's "formulary" (approved list) usually will be less expensive. To find out which prescriptions are covered through your new Marketplace plan, visit your insurer's website, call them directly, or check your Summary of Benefits and Coverage.
  • Regular & emergency care: Most health plans give you the best deal on services when you see a doctor who has a contract with your health plan. While you may be able to see doctors who don’t contract with your plan, visiting an "in-network" provider usually means you'll have lower out-of-pocket costs. But in an emergency, get care from the closest hospital that can help you.

Learn more about using your insurance coverage.

2019 tax season is here! Here’s how to prepare
Thu, 16 Jan 2020 00:00:00 -0500

Attention: 2019 tax filing season has started. Here’s what you can do now to get ready.

2019 tax forms

3 steps to get ready for 2019 tax filing:

  1. Look for Form 1095-A.

    • If you or anyone in your household had a 2019 Marketplace plan, you’ll get Form 1095-A, Health Insurance Marketplace Statement in the mail by early February. It comes from the Marketplace, not the IRS.
    • It may also be available online in your account.
  2. Check Form 1095-A for accuracy.

    • You’ll use Form 1095-A to "reconcile" your premium tax credit if you used advanced payments of the premium tax credit to lower your monthly premium payment, so it’s important the information on it is correct. If you file with an incorrect version, you may need to file an amended return later.
    • Confirm things like your coverage and household information, monthly enrollment premium, and “second lowest cost Silver Plan” (SLCSP).
    • If you find errors, contact the Marketplace Call Center. We’ll send you an updated copy. Wait to file until you have it.
  3. Use your correct 1095-A to “reconcile.”

    • Now that you have an accurate 1095-A and second lowest cost Silver plan premium, you’re ready to fill out Form 8962, Premium Tax Credit.
    • See this step-by-step guide to reconciling for next steps.
Take advantage of free preventive services in 2020
Thu, 02 Jan 2020 00:00:00 -0500

With Marketplace coverage, you have access to free preventive services, like flu shots, check-ups, and screening tests. Getting these recommended services is an important step toward good health and well-being.

Image: {Magnifying glass over doctor's order}

What are preventive services?

  • Preventive services are routine health care procedures, like screenings, check-ups, and counseling to prevent illnesses, disease, and other health problems.
  • Taking advantage of these free services can help detect illness early, when treatment is likely to work best, so talk to your provider about what’s right for you.
  • Note: Preventive services are free only when provided by a doctor or other provider in your plan’s network. (A network is the facilities, providers, and suppliers your health insurer has contracted with to provide health care services. Contact your insurance company to see which providers are “in-network.”)

Where can I learn more?

Now that you’re covered for 2020, don’t forget to pay your premium
Thu, 19 Dec 2019 00:00:00 -0500

Congratulations on your enrollment in a 2020 Marketplace plan! Now that you’re covered, don’t forget to pay your monthly premium to your health insurance company (not the Marketplace) to activate your coverage. Your coverage won’t start until you do.

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Can I pay my premium online?

It depends. Each insurance company handles premium payments differently, so follow your plan’s instructions carefully. If you have the option to pay online, follow these steps:

  1. Log into your Marketplace account.
  2. Choose your application under "Your Existing Applications."
  3. Click the blue button "Pay Your First Health Insurance Monthly Premium."
  4. Choose the green button "Pay for Health Plan Now" to go to your insurance company’s website to pay.

Not sure you’ve paid?

  • Find out if your health insurance is active by checking your online Marketplace account.
  • If you think you're enrolled but have questions about your plan, contact your insurance company. You can also check your plan materials. Your plan should send you a membership package with enrollment materials and a health insurance card.
2020 Open Enrollment is over, but you may have options
Mon, 16 Dec 2019 00:00:00 -0500

Marketplace Open Enrollment for 2020 coverage ended December 15. If you missed the deadline, you may still be able to get or change 2020 coverage two ways:

Image: {Woman carrying moving boxes qualifies for Special Enrollment Period}

With a Special Enrollment Period

  • Since the 2020 Open Enrollment Period is over, you can now enroll in or change a Health Insurance Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.
  • A change in your situation, like getting married, having a baby, or losing health coverage, may make you eligible.
  • Answer a few questions to see if you may qualify.

Through Medicaid or the Children’s Health Insurance Program (CHIP)

  • Medicaid and CHIP provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
  • You can apply for either program any time, all year. If you qualify, you can enroll immediately.
  • Select the second button and answer a few questions to see if you may qualify.

Learn more about your health insurance options outside Open Enrollment.

Last chance: The 2020 Open Enrollment deadline is days away!
Thu, 12 Dec 2019 00:00:00 -0500

Time’s running out for 2020 Marketplace insurance! Open Enrollment for 2020 Marketplace insurance ends Sunday, December 15. This means you have only 3 days to enroll in, re-enroll in, or change a 2020 Marketplace plan.

Image: {Countdown clock for Open Enrollment deadline}

Act now for coverage that starts January 1

  • First time applying at Create an account.
  • Have 2019 Marketplace coverage? Log in to update your application and compare plans for 2020. If you don’t, you could miss out on new plans, and any savings could be wrong. This means you could end up paying more for your monthly premium or owing money on your federal taxes.

Need enrollment help?

Time’s running out! Update & compare Marketplace plans by December 15
Thu, 05 Dec 2019 00:00:00 -0500

If you enrolled in Marketplace health insurance for 2019, you can renew, change, or update your plan for 2020 until Sunday, December 15, 2019. That’s less than 2 weeks away! If you miss the deadline, you may be automatically enrolled for 2020, but that’s not your best option.

Image: {Smartwatch flashing important reminder to update and compare plans}

Why update & compare for 2020 — even if you want to keep the same plan

  • New, affordable plans may be available this year. Just like people, plans and prices change every year. You may find 2020 plans with coverage and features that better meet your needs, especially if you’ve had or expect income or household changes.
  • Get the right amount of financial help for 2020. Savings are based on your expected income for 2020 (not 2019). If your information isn’t current, your premium tax credit and other savings could be wrong. This means you could end up paying more for your monthly premium or owing money on your federal taxes.
  • Sometimes you won't be automatically enrolled. You should enroll in an available plan by December 15, 2019 to be on the safe side.

How to change or renew 2020 coverage

  • Log in to update your application with your expected 2020 income and household information.
  • Compare your current plan with other available 2020 plans. If you want to keep your same plan, you should still update your information and check out all the plans available to you. If you don’t, you could miss out on savings and a plan that better meets your needs.
  • Learn more about changing and renewing coverage for 2020.
Why enroll in 2020 Marketplace coverage
Thu, 21 Nov 2019 00:00:00 -0500

You may think you don't need health insurance, that it's too expensive, or not worth the trouble. While nobody plans to get sick or hurt, bad things happen, even to healthy people. The good news is that enrolling in a 2020 Marketplace health plan may be more affordable and easier than you think. You have until December 15, 2019 to sign up. Coverage starts January 1, 2020.

Image: {Friends stand together holding signs that read "More affordable and easier"}

You may be eligible for savings

Applying can be fast & simple

Only one month left to enroll in or change 2020 Marketplace coverage!
Thu, 14 Nov 2019 00:00:00 -0500

Don’t delay: 2020 Open Enrollment ends December 15, 2019! This means you have just over one month to enroll in or change Marketplace health insurance for coverage starting January 1, 2020.

Image: {Clock ticking down to the 2020 Open Enrollment deadline}

Act now & apply

Enrollment help is available

Quickly find your 2020 Marketplace costs
Thu, 07 Nov 2019 00:00:00 -0500

Open Enrollment for 2020 health insurance is here and ends Sunday, December 15, 2019. Find out in a matter of minutes what your costs may be by answering a few easy questions about you and your household. You don’t even have to log in.

Image: {Man estimating income calculation on calculator for lower costs tool”}

Will I save on a 2020 Marketplace plan?

Find out exact costs & savings when you apply

The 2020 Health Insurance Marketplace is open for business!
Fri, 01 Nov 2019 00:00:00 -0400

Starting today, November 1, you can apply for new 2020 health insurance, or renew, change, or update your 2019 health plan for 2020.

Image: {Woman applies for 2020 Marketplace insurance online at her laptop”}

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How to apply

  • You can apply at or through certified enrollment partner websites, by phone, with the help of a trained assister in your community, through an agent or broker, or with a paper application.
  • See the different ways to apply for 2020 health insurance.

Not quite ready? See plans & prepare

Preview 2020 plans and prices today!
Fri, 25 Oct 2019 00:00:00 -0400

You can enroll in or renew a 2020 plan November 1 through December 15. You can start by previewing 2020 plans with personalized estimates. Note: You’ll see exact prices later on when you fill out or update your Marketplace application.

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How to preview 2020 plans & prices

More on 2020 Open Enrollment & plan shopping