The Affordable Care Act (ACA) put in place comprehensive health insurance reforms that roll out over four years (beginning 2010) and beyond.
The ACA requires new benefits including tax credits that make coverage more affordable, and prohibits insurers from refusing to cover or charge more if someone has a pre-existing condition – like MS. Learn about what the law means for you through these information and resources:
The Health Insurance Marketplace, which may be referred to as the Exchange in some states, is an online health insurance shopping ‘portal’. It allows individuals and families to compare available health plan options, submit an application for health insurance and cost help, and enroll in their chosen health plan. Details about price, benefits, quality and other features are presented to help you select the plan that best meets your needs. Everything you read about your options and costs will be in plain language. Find the Marketplace in your state.
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What do Health Insurance Marketplace plans cover?
Every health insurance plan in the new Marketplace offers comprehensive coverage, including hospitalization, doctors’ visits, prescriptions and more. Under the new law, all health insurance including Medicare and Medicaid plans must cover recommended preventive care (such as cancer screenings and vaccines) at no additional cost to you.
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Will I face a penalty if I do not have health insurance?
You may. This chart ‘The New Requirement to Have Health Insurance or Face a Penalty’ (.pdf) describes exactly who and who does not have to have health insurance or pay a penalty.
Generally, people without health insurance, as well as those who may want to switch to a different Marketplace plan can only enroll in a Marketplace plan during the three month Open Enrollment period – from November 15th to February 15th each year. There are exceptions for those who qualify for a Special Enrollment opportunity due to certain circumstances such as moving out of state, getting married or having a baby. For coverage to begin on January 1st, make sure you enroll by December 15th. Additionally, individuals or families with children but no health insurance can explore their eligibility for Medicaid, or the Child Health Insurance Program for children below age 19, at any time. There is no open enrollment period for Medicaid or CHIP, and you can also learn about and apply for these government-sponsored health insurance programs at Healthcare.gov. .
You can apply for coverage online, over the phone, by mail, and in some places, in-person. When you apply online, you will fill out an application and see all the available health plans in your area. You will need to provide information about your household size and income in order to find out if you qualify for lower monthly premiums, and if you qualify for lower out-of-pocket costs.
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Can I get help reviewing my options and next steps?
Yes, there is a toll-free telephone help line available 24 hours a day, 7 days a week: 1-800-318-2596 (TTY: 1-855-889-4325). There is also an online chat service, as well as specially trained Navigators who offer un-biased information, education and enrollment assistance to consumers at no cost. If you experience difficulty accessing this toll-free help line, try one of the local help providers in your state or community.
Yes. Health plans sold through the Marketplace provide coverage for one year. Every fall, your health insurance company will send you a letter explaining changes to premiums and benefits for the coming year. You can choose to stay in your current plan as long as it is still offered, or switch to another one that is a better fit for your needs and finances. Remember – you can begin comparing your options on November 15th but you only have until February 15th to enroll in a different plan if you need to. If you want to stay enrolled in your current plan, use the plan ID in the letter you get from your health insurer to quickly access your Marketplace account – which you will need to update or confirm your personal information.
Medicaid and CHIP enrollees must re-certify for continued coverage every year as well. Each state has its own process for recertifying enrollees in these programs, Watch for notices from your Medicaid or CHIP plan and follow the procedures carefully.
Call 1-800-318-2596 for help re-enrolling in Marketplace, Medicaid or CHIP health coverage.