According to the Affordable Care Act, 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 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?
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 preventative 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. Those who do not sign up will face tax penalties. 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 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.
If you currently have “charity care,” you are encouraged to sign up for Medicaid. With Medicaid, you will be covered for things like doctors’ visits and medicine. You can sign up for Medicaid at any time of the year.
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.
Open enrollment for 2015 coverage runs from November 15, 2014 to February 15, 2015.
If you live in Michigan, use www.HealthCare.gov to apply for coverage, compare plans and enroll in coverage.
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.
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, 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 >
Premium Assistance for Coverage in Exchanges
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. For more information, click here.
When you compare plans, you'll be able to see what hospitals are included in each one. Make sure you choose a plan that includes Mercy Health locations so you'll always have the latest treatment options, leading-edge technology, and physicians from some of the nation's finest medical schools. Because when you treat the region's most critical patients, you're better at treating everything.
If you bought a health plan through the Marketplace in 2014, you’ll probably be automatically enrolled for 2015. If you don’t take any action, your coverage will start January 1, 2015. But you should update your income and household information to be sure you get the right amount of savings for 2015.
When you get your notice from your health insurance company, you’ll know if you’ll be enrolled automatically.
You can change plans for 2015 coverage, even if you’ll be automatically enrolled in your current plan or a similar plan. 2015 plans and estimated prices will be available in early November.
Enrollment in a similar plan If your insurance company notice says you’ll be enrolled automatically, it will tell you if:
You’ll be enrolled in the same plan you had in 2014
You’ll be enrolled in a similar plan
If you’ll be automatically enrolled in a similar plan: Insurance companies sometimes decide to change which plans they offer in the Marketplace. This is a normal part of their business cycle. If you’re being automatically enrolled in a different plan, your company has decided not to offer your particular Marketplace plan to anyone in your area in 2015.
An insurance company can’t move you to a different plan based on your health or how much care you use. It can move you only if it’s no longer offering the plan you had to anyone in your area.
You can accept the automatic enrollment in the similar plan or change plans.
If you want to change, you must enroll in the new plan by December 15, 2014, for your new plan to start January 1, 2015.
Enrollment with or without your 2014 savings
If you will be automatically enrolled, your Marketplace notice will tell you if:
You’ll have the same premium tax credits and other savings you had in 2014
You won’t get any premium tax credits or other savings
If you will be enrolled without savings, here are two possible reasons:
Updated income information from the IRS shows you may not qualify for savings in 2015
When you filled out your 2014 Marketplace application, you didn’t allow the Marketplace to use your updated tax information for future years
IMPORTANT: You must report changes to the information you provided on your 2014 Marketplace application
You must update the information you provided on your 2014 Marketplace application, like your income, who’s in your household, and whether you can get coverage through a job. This is true even if you accept your automatic enrollment. Learn more about reporting changes.
What if I don’t like the plan my insurance company wants to enroll me in automatically?
Enroll by December 15, 2014, to make sure your new coverage starts by January 1, 2015.
Even if you’re automatically enrolled in the plan you don’t like on January 1, 2015, you can still change plans until Open Enrollment ends on February 15, 2015.
What if I think the information used to determine my savings is wrong?
Starting November 15, 2014, 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. You can then enroll in the plan offered by your insurance company or change to a different one.
Important: After you get your new eligibility results, be sure to finish the application process and enroll in a plan, even if you want to stay in the same plan. If you don’t, your new information won’t be sent to the insurance company.
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 starting November 15, 2014. This is true even if your notice says you’ll be automatically enrolled in your current plan.
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. It also could happen if you didn’t allow the Marketplace to use your updated tax information for future years when you applied for 2014 coverage.
Important: You still may qualify for savings for 2015, so it’s very important to update your 2015 application with your latest 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.)
When you log into your Marketplace account starting November 15, 2014, be sure to update your household, income, and other information on your 2015 application. You’ll get new eligibility results that show the savings you qualify for in 2015. Be sure to pick your same plan and then finish your enrollment.
Important: After you get new eligibility results, you must continue the process and enroll in a plan. This is true even if you want to stay in the same plan you had in 2014 or enroll in the similar plan your insurance company is offering. If you don’t finish the new enrollment, your insurance company won’t get your updated information.
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.
If you change from your current plan for any reason, it’s particularly important to do this.
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 auto-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.
Important: When you get new eligibility results, you must finish the process and enroll in a plan, even if it’s the one you currently have. If you don’t, your insurance company won’t get your new information.
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.
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 Marketplace?
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.