Health Insurance Blog - Healthcare.gov
Choosing a Marketplace plan that meets your household's needs
Thu, 15 Oct 2020 00:00:00 -0400

Open Enrollment for 2021 coverage starts November 1. Plans have different premiums and out-of-pocket costs and may differ in the quality of service and benefits they provide. Knowing a few things before you apply can make the process for choosing a plan simpler.

Image: Things to think about when picking a plan

Things to think about when comparing Marketplace plans

  • There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
  • HealthCare.gov offers health insurance plan quality ratings (or "star ratings"), that reflect member experience, medical care, and health plan administration. The ratings let you quickly compare plans based on quality.
  • When choosing a plan, it’s a good idea to think about your total health care costs. You pay a monthly bill to your insurance company (a "premium"), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care.
  • Some plan types allow you to use almost any doctor or health care facility. Other plans limit your choices or charge you more if you use providers outside their network.

Learn more about choosing the health plan that right’s for your family.

3 ways to get ready to apply for 2021 coverage
Thu, 08 Oct 2020 00:00:00 -0400

With Open Enrollment for 2021 less than a month away, make sure you’re prepared. Whether you’re enrolling for the first or fifth time or planning to renew your current plan, taking small steps to get ready now can help the application process run smoothly when you apply for coverage starting November 1.

Prepare for Open Enrollment with these quick tips

3 quick & easy ways to get ready for Open Enrollment

  • Learn how the Marketplace works by reading these quick tips. If you come across an unfamiliar term, visit our glossary.
  • See if your income is in the range to get help with costs. Enter your household and expected income information, and we'll show you how much you may save. You'll know the exact amount you'll pay after you submit an application.
  • When you fill out your application, you'll be asked to predict your income. Marketplace savings are based on your expected household income for 2021, not 2020. See what counts as income so you’ll make an accurate estimate.
Open Enrollment is one month away!
Thu, 01 Oct 2020 00:00:00 -0400

Mark your calendar: Open Enrollment for a 2021 Marketplace plan starts November 1, exactly one month from today.

Open Enrollment for 2021 coverage starts November 1

Other important Open Enrollment deadlines:

  • Open Enrollment runs from November 1 through December 15, 2020. Coverage starts January 1, 2021.
  • If you don’t enroll in a plan by December 15, you can only get 2021 Marketplace coverage if you qualify for a Special Enrollment Period.

Here’s how you can get ready today to apply for 2021 coverage.

Sign up for Marketplace reminders & important info
Thu, 24 Sep 2020 00:00:00 -0400

With Open Enrollment for 2021 coverage just over a month away, sign up today for deadline reminders and useful tips so you don’t miss out on late-breaking information.

Image: Never miss an update from the Marketplace

How to connect with the Marketplace

  • Get updates via email or text. Visit HealthCare.gov and enter your email address under "Get Important News & Updates." Click "Sign Up."
  • Connect with us on social media. Follow us on Twitter and like us on Facebook for news, interactive content, and important updates.
  • Find someone to help answer your enrollment questions. Enter your ZIP code for a list of groups and people in your area. Some offer help in languages other than English and other specialized services.
Get the flu shot this fall
Thu, 17 Sep 2020 00:00:00 -0400

The Centers for Disease Control and Prevention (CDC) recommends everyone 6 months and older get a yearly flu shot by the end of October. By getting the shot, you’re helping to lower the spread of flu-related illnesses, hospitalizations, and even death.

Image: Don’t delay! Get your flu shot today

3 more reasons it’s important to get your flu shot:

  • With Marketplace health insurance, your flu shot is free from a provider in your plan's network. Immunization vaccines are a covered preventive care benefit.
  • While babies, children, and older people are most vulnerable, no one is immune from the flu.
  • Getting vaccinated is more important than ever. Getting the shot helps reduce illness and preserve health care resources as the country battles the coronavirus disease 2019 (COVID-19) emergency.

According to the CDC, the flu vaccine doesn’t increase the risk of getting COVID-19. When you get your shot, try your best to maintain social distancing, avoid waiting areas, and always wear a mask.

Marketplace health benefits & coverage: What to know
Thu, 10 Sep 2020 00:00:00 -0400

All plans offered in the Marketplace, cover a set of 10 essential health benefits, including ambulatory patient services, emergency care, and pregnancy, maternity, and newborn care.

Image: See what’s covered by Marketplace insurance plans

See the full list of covered essential health benefits. Specific services covered can vary based on your state’s requirements. Some plans may offer vision, dental, and medical management programs. When comparing plans, you’ll see exactly what each plan offers.

Also covered: Preventive care & coverage for pre-existing conditions

Marketplace plans cover a set of preventive services, like shots and screening tests, at no cost to you when delivered by a provider in your plan’s network.

No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started, including pregnancy.

Learn more about what Marketplace health insurance plans cover.

Life change? You may be eligible for health coverage for the rest of 2020
Thu, 03 Sep 2020 00:00:00 -0400

If you recently lost health coverage, got married, had a baby, or experienced another life event, you may qualify for a Special Enrollment Period to enroll in or change Marketplace coverage for the rest of 2020.

Image: 4 types of life events for Special Enrollment Period eligibility

What counts as a life event?

There are 4 basic types of qualifying life events:

  • Loss of health coverage, like losing your job-based or student health plan
  • Changes in household, like getting married or divorced, having a baby, or adopting a child
  • Changes in residence, like moving to a different ZIP code or state
  • Other changes that impact your income or status, like gaining membership in a federally recognized tribe

How to apply with a Special Enrollment Period

Learn more about applying for Marketplace coverage through a Special Enrollment Period.

When can I enroll in a 2021 Marketplace plan?
Thu, 27 Aug 2020 00:00:00 -0400

Here are some important Open Enrollment dates for 2021 coverage to mark on your calendar:

Image: Key 2021 Open Enrollment dates

Key Open Enrollment dates

  • Open Enrollment runs from Sunday, November 1 through Tuesday, December 15, 2020. Coverage begins January 1, 2021.
  • If you don’t enroll in a plan by December 15, you can’t get 2021 coverage unless you qualify for a Special Enrollment Period.

Looking for coverage for the rest of 2020? Answer these questions to see if you can apply through a Special Enrollment Period. You can also enroll in Medicaid or CHIP any time, if you’re eligible. Coverage can begin immediately.

Recently lose health coverage? You may qualify for a Special Enrollment Period
Thu, 13 Aug 2020 00:00:00 -0400

You may qualify for a Special Enrollment Period to enroll in or change health plans if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose it in the next 60 days.

Image: Coverage losses that may qualify for a Special Enrollment Period

Coverage losses that may qualify

  • Losing job-based coverage, like through your employer or the employer of a family member.
  • Losing individual health coverage for a plan or policy you bought yourself, like if your plan is discontinued or you lose eligibility for a student health plan.
  • Losing Medicaid or Children’s Health Insurance Program (CHIP) coverage, like if a change in household income makes you ineligible for Medicaid or your child ages off CHIP.
  • Losing Medicare eligibility, like if you’re no longer eligible for premium-free Medicare Part A.
  • Losing coverage through a family member, like if you turn 26 and can no longer be on a parent’s plan.

Not sure your coverage loss counts? Answer a few questions to see if you qualify.

Ready to apply through a Special Enrollment Period?

Note: If you're not eligible to apply with a Special Enrollment Period for the rest of 2020, you can apply for a 2021 health plan Sunday, November 1 through Tuesday, December 15, 2020.

New baby means new health insurance options
Wed, 29 Jul 2020 00:00:00 -0400

Congratulations on your new addition! If you recently had a baby or adopted a child, you may be eligible for a Special Enrollment Period. This means you can enroll in or change your Marketplace plan even though it’s not Open Enrollment. Your new coverage can start the day of the birth or adoption, even if you enroll in the plan up to 60 days afterward.

Image: How to apply with a Special Enrollment Period after baby

How to apply with a Special Enrollment Period

Other life changes that may qualify

  • Having a baby isn’t the only life event that makes you eligible for a Special Enrollment Period. Coverage and income changes also count.
  • Answer a few questions about your life event to see if you may qualify.
  • You can also check out the full list of life events.
Report life changes year-round
Thu, 16 Jul 2020 00:00:00 -0400

If you have Marketplace coverage and your income or household changes, update your application as soon as possible. These changes may affect the coverage or savings you’re eligible for.

Image: See which changes to report & how to report them

Which changes to report

  • Certain changes to your yearly expected income, household members, and status (like disability or tax filing status) may qualify you for a Special Enrollment Period so you can change plans outside the annual Open Enrollment Period.
  • Changes may affect the savings and coverage options you qualify for, so it’s important to report them right away.
  • If you don’t report changes, you could wind up getting the wrong amount of savings and owing money when you file your next tax return.

How to report changes

  • Report changes to the Marketplace by updating your application.
  • You can update your application online, by phone, or in personbut not by mail.
  • After you finish, you may be asked to submit documents to confirm your changes.

Learn more about reporting income and household changes after you're enrolled.

Moving may impact your health coverage
Thu, 02 Jul 2020 00:00:00 -0400

Summer is a popular time for moving. Depending on whether you move to a different state, your move may impact your current health plan.

Image: Reporting a move & your health coverage

Moving to a different state

  • When you move to a new state, you can’t keep your current plan.
  • Report your out of state move to the Marketplace ASAP. This way, you can enroll in a new plan without a break in coverage, and you won’t pay for coverage that doesn’t apply in your new state.
  • When you move out of state, you’ll need to start a new Marketplace application and enroll in a plan in your new state.
  • Where to apply depends on whether your new state uses HealthCare.gov or its own website. Choose your new state to get started.

Moving within the same state

  • Your coverage options and savings probably won’t change based on your new address.
  • You should still update your address on your application just in case new savings and plans are available to you.
  • See how to update your address online.

Learn more about reporting a move to the Marketplace.

Use Marketplace coverage to improve your health
Thu, 18 Jun 2020 00:00:00 -0400

Health coverage is important even when you don’t feel sick. No matter your health status, there are things you can do proactively to lead a healthier life.

Image: Why prevention and health coverage are important

Why are prevention and health coverage important?

  • Staying healthy is important for you and your family. Taking small steps, like eating a well-balanced diet, making time for physical activity, and getting enough sleep, will improve your lifestyle at home, work, and in the community.
  • Preventive services, like screenings, check-ups, and patient counseling, can help prevent illnesses, disease, and other health problems. They can also detect illness at an early stage when treatment is likely to work best.
  • Ask your provider which services are most beneficial to you. Preventive services are free when delivered by a doctor or other provider in your plan’s network.

Learn more about using your coverage.

Calling all graduates: You have health insurance options
Thu, 04 Jun 2020 00:00:00 -0400

Graduation is an important milestone. As you embark on the next phase of your life, it’s also important to have health insurance to protect you from unexpected medical costs.

Image: Affordable health coverage for college grads

Why bother with health insurance

  • Nobody plans to get sick or hurt, but bad things happen, even to healthy, young people. Treating a broken leg can cost $7,500, and a 3-day hospital stay can total $30,000. That’s a lot of money, especially when you’re just starting out!
  • Applying for Marketplace coverage may be faster and easier than you think. With one application, you’ll find out if you’re eligible for a health plan with savings based on your income. You may qualify for free or low-cost coverage through Medicaid.
  • Note: If someone claims you as a tax dependent, you can buy a plan through the Marketplace, but you won't qualify for savings based on your income.

How to get affordable health coverage

If you’re under 30, you can get health coverage a few different ways, some designed specifically for you.

  • If you’re under 26, you may be able to enroll on a parent’s health insurance plan.
  • You can buy your own Marketplace plan at HealthCare.gov. Depending on your situation, you may be eligible for savings based on your income.
    • If your student health plan is ending, you’re moving to a new state, or you experience other life changes, you may qualify for a Special Enrollment Period to enroll in Marketplace insurance for the rest of 2020.
    • This means you don’t have to wait until the next Open Enrollment Period this fall to apply for 2021 coverage.
    • See if you're eligible to apply right away.

Get more information on health insurance options for young adults.

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 HealthCare.gov 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 disease 2019 (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 COVID-19:

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 COVID-19, please visit: coronavirus.gov


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