Affordable Health Insurance

Health Insurance Provides Peace of Mind

Health insurance can be affordable. For some, government subsidies offset the cost of insurance. Others may be eligible for Medicaid when previously they were not. Avoiding penalties for not having insurance should be a factor too. Most importantly, health insurance provides peace of mind.

The Heath Care Law

According to the Affordable Care Act, everyone who legally lives in the United States must have health insurance.

For millions of uninsured people, this law gives access to healthcare plans at different cost levels. Based on their income and family size, those who qualify also may receive financial assistance when purchasing these plans.

You may compare plans at the Health Insurance Marketplace, also known as an exchange. This one-stop shop allows you to choose a plan that fits your budget and coverage needs.

We’re here to help you learn about the law and how to select the right plan for you and your family.

What Will the Plans Cover?

All plans include coverage for doctor visits, hospital stays, wellness care, prescriptions, emergency services and more. In fact, there are 10 essential health benefits that are included in every plan, and certain preventive care services will be provided at no additional cost to patients. Insurers cannot deny coverage because of pre-existing conditions.

Open Enrollment Begins November 1

If you do not have health insurance, you must sign up for 2016 coverage during open enrollment, from November 1, 2015 to January 31, 2016. You can shop for plans by phone, through a broker or at the online Marketplace, where you can compare benefits and costs easily. Those who do not sign up will face tax penalties.

If you currently have “charity care,” you should sign up for health coverage. With health insurance, you will be covered for things like doctors’ visits and prescription medicines, which are not covered now – and may not be covered when your charity care coverage ends.

If you are interested in receiving one-on-one assistance to compare insurance options, call 413-748-9357 to speak with an enrollment representative.

Or visit Healthcare.gov for additional information.

Renewing Your Marketplace Health Insurance Plan

The Open Enrollment Period is when individuals can purchase health insurance plans. If you already have health insurance, it is the time for you to shop for new Marketplace coverage or decide to stay in the same, or a similar, plan. This year, the Marketplace Open Enrollment Period is from November 1, 2015 through January 31, 2016.

Your health insurance company will send you a letter by November 1, 2015 to let you know if your plan is still being offered and how the plan is changing.

• If your health insurance company will offer a plan in your area for 2016: The letter you get from your health insurance company will tell you the new monthly premium amount and any changes to the plan. If you have questions about plan benefits, which providers are in-network, or how to pay your premiums, call your health insurance company directly.
• If your health insurance company won't offer a plan in your area for 2016: Your health insurance company may decide to stop offering certain plans next year. If your health insurance company won't offer a plan in your area for 2016, then you'll need to choose a new plan for 2016 to continue having coverage.

Be sure to go to HealthCare.gov to make sure your current plan is still right for you. Be sure that the plan works for you – for example, that the doctors and hospitals you use, and prescription drugs you need, are still in-network. In most cases, if you do not take action, your health insurance company will automatically enroll you in the plan you currently have or the one most similar to it if your plan is no longer available.

From November 1, 2015 to January 31, 2016, you can:

• Update your application information.
• See if you qualify for new or different help paying for your premiums and out-of-pocket costs.
• Compare available plans.
• Enroll in a plan that meets your needs.

Remember, you must enroll in a plan by December 15, 2015 for coverage in your new plan to start on January 1, 2016.

To learn more about making updates, visit www.HealthCare.gov/keep-or-change-plan/. You can also call the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.

A surprisingly large number of people qualify for financial help when buying health insurance through the Marketplace.

For example, someone who earns up to $47,080 a year, or a family of four earning up to $97,000 a year, qualifies for reduced monthly premiums or a tax credit at the end of the year.

By using one of several good calculators that are available, you can estimate how much assistance you may obtain—before you even visit the Marketplace site (www.HealthCare.gov). However, only the Marketplace will let you know the exact assistance you can expect.

Financial Assistance Calculator

One very simple calculator can be found at Get Covered USA: http://www.getcoveredamerica.org/calculator/

Another calculator option, from the Kaiser Family Foundation, is found below:

This tool estimates health insurance premiums and subsidies for people purchasing insurance in the Marketplace. It was developed by the Kaiser Family Foundation.

You can enter different incomes, ages and family sizes to estimate your eligibility for subsidies and how much you could spend on health insurance.

Financial Assistance Income Chart

Look for your income and household size on this chart to see whether you qualify for financial assistance when purchasing health insurance.

When you compare plans, you’ll be able to see which hospitals are included in each one.

Be sure to choose a plan that includes Sisters of Providence Health System so you’ll always have the latest treatment options, leading-edge technology and the region’s top-rated and most experienced physicians.

To learn more and find a solution right for you, call 413-748-9357 to speak to an enrollment representative.

All marketplace plans must cover the following list of preventive services without charging you additional fees (copayment or coinsurance), even if you haven't paid your yearly deductible. However, you must receive these services from a health care provider in your network. Screenings are also available based on certain criteria and conditions.

Preventive Screenings For All Adults

1. Abdominal aortic aneurysm one-time screening
2. Alcohol misuse screening and counseling
3. Aspirin use
4. Blood pressure screening
5. Cholesterol screening
6. Colorectal cancer screening
7. Depression screening
8. Diabetes (Type 2) screening
9. Diet counseling
10. HIV screening
11. Vaccines and immunizations
12. Obesity screening and counseling
13. Sexually transmitted infection (STI) prevention counseling
14. Syphilis screening
15. Tobacco use screening

Preventive Screenings For Women

1. Anemia screening
2. Breast cancer genetic test counseling (BRCA)
3. Breast cancer mammography screenings
4. Breast cancer chemoprevention counseling
5. Breastfeeding comprehensive support and counseling
6. Cervical cancer screening
7. Chlamydia infection screening
8. Contraception
9. Domestic and interpersonal violence screening and counseling
10. Folic acid supplements
11. Gestational diabetes screening
12. Gonorrhea screening
13. Hepatitis B screening
14. HIV screening and counseling
15. Human papillomavirus (HPV) test
16. Osteoporosis screening
17. Rh incompatibility screening
18. Sexually transmitted infection (STI) counseling
19. Syphilis screening
20. Tobacco use screening and interventions
21. Urinary tract or other infection screening
22. Well-woman visits

Preventive Screenings For Children

1. Alcohol and drug use assessments for adolescents
2. Autism screening
3. Behavioral assessments
4. Blood pressure screening
5. Cervical dysplasia screening
6. Depression screening
7. Developmental screening
8. Dyslipidemia screening
9. Fluoride chemoprevention supplements
10. Gonorrhea-preventive medication
11. Hearing screening
12. Height, weight and body mass index measurements
13. Hematocrit or hemoglobin screening
14. Hemoglobinopathies or sickle cell screening
15. HIV screening
16. Hypothyroidism screening
17. Immunization vaccines
18. Iron supplements
19. Lead screening
20. Medical history
21. Obesity screening and counseling
22. Oral health risk assessment
23. Phenylketonuria (PKU) screening
24. Sexually transmitted infection (STI) prevention counseling and screening
25. Tuberculin testing
26. Vision screening

All private health insurance plans on the Health Insurance Marketplace provide the same essential health benefits.

These are minimum requirements, but plans may offer additional coverage. Compare plans side-by-side on the Marketplace to see exactly what each offers.

Essential Health Benefits

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services

Source: 
www.healthcare.gov/coverage/what-marketplace-plans-cover