Marketplace Basics

Marketplace Basics

Under the Affordable Care Act, all Americans must have basic health coverage starting in 2014. Individuals & small businesses can buy affordable health insurance plans in this new, competitive marketplace. Open Enrollment for 2016 starts November 1, 2015 and ends January 31, 2016.

 

Here’s a quick 101 to get you started…

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What is the Health Insurance Marketplace?

The Marketplace is a new way to find quality health coverage. With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll. Open Enrollment is the period of time in which you can shop in the Marketplace.

 

umbrellaIconWhat do plans in the Marketplace cover?

Insurance plans in the Marketplace cover core set of benefits called essential health benefits. Plans can’t charge women more than men for the same plan. Many preventive services are covered at no cost to you. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

 

rainbow-button-23148250If my partner and I are legally married in another state, can we apply as a household?
UPDATE: The Supreme Court announced their long-awaited decision in Obergefell v. Hodges on June 26, 2015! What it means for your health coverage in GA:
  • The United States Supreme Court has ruled in favor of the freedom to marry across the nation.
  • The Affordable Care Act always had the ability for same-sex couples married in jurisdictions that recognized same-sex marriage to apply as a married couple.
  • Now that all 50 states recognize marriage equality, if you get legally married, including in the state of Georgia, you qualify for a Special Enrollment Period.

 

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But what if I have a pre-existing condition?

No plan can turn you away (or charge you more) because you have an illness or medical condition. They must cover treatments for these conditions. This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.

 

 

23-wood-awning-shop-open-iconWho can shop in the Marketplace?

The only people who cannot shop the Marketplace are those that have insurance plans through their employers (master policy held by the employer) or are covered by another insurance plan (i.e. Medicare, Medicaid, TriCare, etc) . In other words, if you are uninsured, under-insured, self-employed, or self-insured you’re eligible. Small businesses with 50 or fewer full-time equivalent employees can also use the Marketplace.

UPDATE: The Supreme Court announced their long-awaited decision in King v. Burwell in June of 2015. The Court decided in favor of the federal government. This is a huge victory for consumers. What it means for your health coverage in GA:

  • The decision confirms that individuals who qualify for tax credits are eligible to receive them, regardless of the state they live in or the type of marketplace.
  • Consumers who are receiving tax credits will continue receiving them. Nothing changes to impact their insurance coverage.
  • Consumers should continue to pay their premiums as usual.
NoReallyStopHow do I pick a plan if I’m HIV+?

The Ryan White will continue to be available for individuals living with HIV and whose income falls below 300% of the Federal Poverty Level. This includes the AIDS Drug Assistance Program (ADAP).  Ryan White funded services will include those core medical and supportive services that are not reimbursable through a private insurance plan or for those who have plans that do not adequately cover their antiretroviral medications.

In addition to this, those residents of the 20 county Part A EMA will be able to apply for additional assistance with out of pocket expenses later this year. The application process and eligibility criteria has not yet been finalized, but we will share that information once we receive it from the Fulton County Ryan White office. Individuals are also encouraged to speak with their case manager or other medical service provider regarding what insurance networks their current providers are listed in.

For individual who make above 300% of the Federal Poverty Level and who are having trouble paying for their HIV medications, they should work with their health care provider to determine what assistance may be available through patient assistance programs offered by individual pharmaceutical companies. If you would like to be notified with HIV related updates, click here.

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