enrolling in Health Insurance Marketplace plans
Looking for affordable health coverage for 2016? are you covered? partners can help.
The Health Insurance Marketplace is available to people without health coverage. If you don’t have a plan through your workplace, Medicare, Medicaid, or another source that provides qualified plans, the Marketplace can get you covered.
Open enrollment begins November 1, 2015 for 2016 Marketplace plans and ends January 31, 2016.
are you covered? partners are working throughout Ohio to provide consumers with free, impartial information and assistance with signing up for health insurance through the Marketplace and Medicaid. Trained counselors can answer questions, point you in the right direction or sit down with you and go through the process step-by-step.
- Visit www.healthcare.gov or get help by phone at 1-800-318-2596 or TTY: 1-855-889-4325.
- You can get free assistance in the enrollment process from areyoucoveredohio.org by calling 1-800-648-1176 or making an appointment with our counselors near your home or workplace.
enrolling in Medicaid
Unlike the Marketplace, Medicaid does not have an open enrollment period, and accepts new applications year round. are you covered? partners work with Ohioans to determine if they are eligible for coverage through Medicaid. The following individuals may qualify for Medicaid coverage in Ohio and should contact an are you covered? counselor for free help with the application process:
- Children up to 19 years old
- Parents or caretaker relatives of children up to 19 years old
- Some 19 and 20 year olds
- Adults up to age 64 living at or below 138 percent of the federal poverty level
- Pregnant women
- Some women with breast and/or cervical cancer
- Adults aged 65 and older
- People with disabilities, including blindness as determined under the Social Security rules
- Some immigrants may be eligible for Medicaid
what it covers
No one plans to get sick or hurt, but most people need medical care at one time or another. Health coverage helps pay for these costs and protects you from very high expenses. When you buy a health insurance plan, the company agrees to cover part of your medical costs when you get sick or hurt.
Did you know the average cost of a three-day hospital stay is $30,000? Or that fixing a broken leg can cost up to $7,500? Having health coverage can help protect you from unexpected high costs like these.
Your health insurance plan will show what types of care, treatments, and services are covered, including how much the insurance company will pay for different treatments.
In general, your health insurance will cover the most important benefits you need:
- Doctor visits
- Prescriptions, including birth control
- Maternity and infant care
- Mental health
- Emergency services
Health insurance covers preventive services, too, and many of them are at no additional cost to you. These preventive services include:
- Cholesterol screening
- Blood pressure screening
- Colorectal cancer screening
- Pap smears
are you covered? connects Ohioans to free information and assistance to sign up for health insurance through a company or through Medicaid. Our services are free, and we are a trusted network of local non-profit and health care organizations with a sole focus of making sure you have the health insurance plan that best fits your needs.
When can I sign up for health insurance?The first step is to meet with a certified assister or log on to healthcare.gov to find out if you are eligible to purchase insurance on the Marketplace. If you are, you can enroll in a plan that meets your needs during open enrollment, November 1, 2015 – January 31, 2016. After that deadline you will have to qualify for a Special Enrollment Period due to a life change.
How much will my new health insurance cost? Can I get financial help?More than half of all uninsured Americans can get covered for under $100 a month. And four out of five people who have already signed up received help paying for their insurance.
The amount of financial assistance works on a sliding scale based on an individual’s or family’s income. Some people will qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP).
What does are you covered? do and how do you do it?are you covered? provides the only statewide network of trained counselors and navigators, working in all 88 Ohio counties. We coordinate the work of 250 organizations who want to make sure all Ohioans have access to affordable health insurance.
Through our local partners, we reach out to communities and neighborhoods throughout Ohio. Our counselors arrange times and locations to meet that are convenient for busy families. We take all the time you need to walk through the process of selecting a health insurance plan, and make sure it meets your health and financial needs.
Will my health insurance cover my doctor?Counselors and navigators from are you covered? will work with you to make sure your plan will meet your needs. We understand how important it is to maintain relationships with your doctors. are you covered? can help you if you want to check which plans cover your current health care professionals -- before you decide which plan to buy.
Can I go to my regular pharmacy? Will my prescription be covered?Not all health plans offer prescription coverage the same way. Since some health plans partner with certain pharmacies to provide you with prescription coverage, we'll help you check to see if your pharmacy is covered in the health insurance plan's network. For some drugs that you take every day, you may need to fill prescriptions by mail.
Will I have to pay some out-of-pocket costs myself?Your share of your health care costs (in addition to your monthly insurance bill) is called out-of-pocket costs. There are three kinds of out-of-pocket costs:
Deductible. You must pay this amount each policy period (which usually lasts one year) for covered services before your insurance kicks in. For example, if your deductible is $1,500, you will pay 100 percent of your health care expenses until you have spent $1,500. Preventive care (such as annual checkups) is free, and does not count toward your deductible.
Co-pay, or co-payment. A co-pay is a set amount that you pay for health care services. For example, you might have a $25 co-pay for visits to your doctor, or $75 for emergency room visits.
Coinsurance. Coinsurance is the portion of health care costs that you are responsible for once you’ve met your deductible (see above). It’s usually a percentage, such as 20 percent. So if a doctor’s visit cost $500 and your coinsurance is 20 percent, your share is $100.
Out-of-pocket maximum. This is the maximum annual out-of-pocket cost to you, including deductibles, co-pays and coinsurance.