Mount Carmel Health System

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Affordable Health Insurance is Here

The Health Care Law
According to the Affordable Care Act (ACA), everyone who legally lives in the United States must have health insurance. In addition, for millions of uninsured people, this law gives access to healthcare plans at different cost levels. Based on income and family size, those who qualify may also receive financial assistance when purchasing these plans. Those who do not have health insurance will face tax penalties. 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?

Coverage includes doctor visits, hospital stays, wellness care, prescriptions, emergency service and more. In fact, 10 essential health benefits must be covered 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.

Get Covered. Stay Covered.

Open enrollment for 2015 coverage runs from November 15, 2014 to February 15, 2015. If you do not have insurance, visit the Marketplace at www.HealthCare.gov. There you can compare benefits and costs easily. If you need assistance, call the Marketplace at 1-800-318-2596. You also can work with a Certified Application Counselor or a broker. If you want coverage to start on January 1, 2015, purchase your coverage no later than December 15, 2014.

If you purchased insurance through the Marketplace last year, in many cases you will be automatically re-enrolled for 2015. You will receive a notice from the Marketplace and your insurance carrier if you will be automatically renewed. You also can shop for a new plan. If your income or household size has changed, you will need to report that to the Marketplace so you get the right premium tax credit. If you do not update this information, you will get the same tax credit as in 2014. If your income has gone up or your household size changes and you do not report these changes to the Marketplace, you may owe money when you file your tax return in 2015.

Penalties

If you or your dependents don’t have insurance that qualifies as minimum essential coverage you'll pay either a percentage of your household income or a flat fee -- whichever is higher.

The Fee in 2015

If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:

  • 2% of your yearly household income (only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty). The maximum penalty is the national average premium for a bronze plan.
  • $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

The Fee For Not Having Coverage in 2014

If you didn’t have coverage in 2014, you’ll pay one of these two amounts when you file your 2014 federal tax return:

  • 1% of your yearly household income (only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty). The maximum penalty is the national average premium for a bronze plan.
  • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

The Fee After 2015

The penalty increases every year. In 2016 it’s 2.5% of income or $695 per person. After that it's adjusted for inflation.

How You Pay The Fee:

You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. Most people will file their 2014 returns in early 2015 and their 2015 returns in early 2016.

 

The New Marketplace

The Health Insurance Marketplace is available online, by phone or through an approved insurance broker. It’s designed to help you buy health coverage more easily.

You can compare plans side by side, in simple language, and there’s no fine print. You can choose between four levels of health plans—Platinum, Gold, Silver and Bronze—from a variety of approved insurance providers. Each offers different amounts of coverage and different monthly premiums. Only one simple application is required.

Now Open!

If you live in Ohio, use www.HealthCare.gov to apply for coverage, compare plans and enroll in coverage.

 

Automatic Plan Renewal

If you bought a health plan through the Marketplace in 2014, you will be automatically enrolled for 2015 and your coverage will start January 1, 2015. Even if you are automatically enrolled in 2015, you must report any changes to the information you provided in your 2014 application (this includes your income, who is in your household and whether you can get coverage through a job). To update your information, log into your Marketplace account. Learn more about reporting changes.

If your insurance company is no longer offering your plan in central Ohio, they will automatically enroll you in a similar plan. You can accept enrollment in the new plan or can change to a different plan. If you want to change, you must enroll in a new plan by December 15, 2014 to get coverage on January 1, 2015.

Questions and Answers:

What if I don't like the plan my insurance company wants to enroll my in automatically?

You can enroll in a different plan. Learn how to change your plan for 2015.

  • You can change plans until Open Enrollment ends on February 15, 2015.
  • However, if you want your new coverage to start on January 1, 2015, you must enroll by December 15, 2014.

What if I'm being automatically enrolled in the same plan, but the premiums and copayments have gone up?

If your plan’s prices and benefits no longer meet your needs, you can change plans for 2015 during Open Enrollment.

What if my notice says I'll be automatically enrolled, but without the tax credit and savings I had in 2014?

This may happen if income information from the IRS shows you may not qualify for savings in 2015 or if you didn’t allow the Marketplace to use your updated tax information for future years when you applied for 2014 coverage.

What if I think the information used to determine my savings is wrong?

Log into your Marketplace account and update your 2015 Marketplace application with the right information. You’ll get new eligibility results, which will show any savings you qualify for in 2015 based on the updated information you provided. In order for your updated information to be sent to your insurance company, you will need to complete the application process and enroll in a plan, even if you wish to stay in the same plan. Learn more about updating your 2015 application with income and household information.

Instead of letting automatic enrollment happen, can I go into my Marketplace application and sign up for my same plan again?

Yes, as long as the same plan is being offered in 2015. Your insurance company notice will say if it is.

Tip: You’ll need the plan identification number from the notice you get from your insurance company to make sure you sign up for the same plan, or for the similar plan your insurance company is offering. (You can also find the number for your current plan on your My Plans & Coverage page in your Marketplace account.)

How do I find out if my plan or provider network will change for 2015?

If keeping access to certain providers is important to you, check with your insurance company to make sure they’ll still be in the plan’s network in 2015. You also can contact your providers directly to see which Marketplace plans they will accept in 2015.

What if I don’t update my income and household information until after my automatic enrollment happens?

Just log into your Marketplace account and make the updates to your 2015 application as soon as possible after the automatic enrollment happens. When you update your information, you’ll get new eligibility results. Your premium tax credits and other savings may change based on your new information. You could also qualify for different coverage.

What is I sign up for a plan and then change my mind?

You can change plans any time until February 15, 2015. After this deadline, you can’t change plans for the rest of 2015 unless you qualify for a Special Enrollment Period.

If I'm being automatically enrolled with a premium tax credit, will it be updated based on new income information from the IRS?

No. When you’re automatically enrolled with a premium tax credit and other savings, your savings are the same as you had in 2014. That’s why it’s so important to update your income and household information to report changes you had in 2014 and expect for 2015. If you don’t do this:

  • You could wind up getting less savings than you qualify for in 2015.
  • You could also wind up having to pay back premium tax credits you didn't qualify for on your 2015 federal tax return

What if my notice says I'll be automatically enrolled in a plan outside the Marketplate

Some insurance companies offer certain plans in the Marketplace and other plans outside the Marketplace. If your company will automatically enroll you in a plan outside the Marketplace for 2015, you have the same choices as anyone who’ll be enrolled automatically. You can accept the automatic enrollment or change plans.

Important: If you enroll in a plan outside the Marketplace, you aren’t eligible for premium tax credits or lower out-of-pocket costs on your coverage. You must use the Marketplace to enroll if you want to qualify for savings. Check out this chart to see if your income falls within the range to qualify for savings.

Financial Assistance

A surprisingly large number of people qualify for financial help when buying health insurance. For example, someone who earns up to $45,900 a year, or a family of four earning up to $94,200 a year, qualifies for reduced monthly premiums or a tax credit at the end of the year.

The Marketplace will let you know the exact assistance you can expect, but if you want to estimate how much assistance you may obtain before you even visit the Marketplace site, you can use one of the following calculators:

http://www.getcoveredamerica.org/calculator/

http://kff.org/interactive/subsidy-calculator/

Why Choose Us?

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

The following plans on the Marketplace include Mount Carmel:

  • Anthem Blue Cross & Blue Shield
  • Aetna
  • Med Mutual Market
  • United Health Care
  • InHealth

 

 

 

 

 

 

 

 

Preventive Care Services

All marketplace plans must cover the following list of preventative services without charing you additional fees (copayment or coinsurance), even if you haven't paid your yearly deductible. However, you must receive these services from a healthcare 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. Immunization vaccines
  12. Obesity screening and counseling
  13. Sexually transmitted infection (STI) prevention counseling
  14. Syphilis screening
  15. Tobacco use screening

Preventative 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. Hepatits B screening
  14. HIV screening and counseling
  15. Human papillomavirus (HPV) DNA test
  16. Osteoporosis screening
  17. Rh incompatiblity 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

Preventative 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 screenign
  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
 

10 Essential Health Benefits

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

 

Resources

There is much to learn about the new healthcare law. We are here to help. Mount Carmel Health System is creating a health insurance library here to help you learn as much as you can to make the best decision for you and your family.

Contact Us:
Have questions about the Health Insurance Marketplace? Counselors are available to speak with you and answer your questions.
Call (614) 546-4929 or email insurancemarketplace@mchs.com

 
©  2014  

Mount Carmel Health System  |  Columbus, Ohio

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