Affordable Care Act Marketplace Insurance | Billing | Loyola Medicine

Affordable Care Act Marketplace Insurance

If you need health insurance or are making sure you have the insurance plan that is right for you, there are resources to help you. Health insurance can be affordable. For some, government subsidies offset the cost of insurance. Others who are seeking insurance may be eligible for Medicaid when previously they were not. Avoiding penalties for not having insurance should be a factor too. Most importantly, health insurance provides peace of mind.

Plans are offered through the Health Insurance Marketplace during an annual open enrollment period. The most recent open enrollment was November 1–December 15, 2017, for 2018 health insurance.

Choosing a Plan

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

Be sure to choose a plan that includes Loyola Medicine so you'll always have the latest treatment options, leading-edge technology and the region's top-rated and most experienced physicians.

Loyola Medicine, including Loyola University Medical Center and Gottlieb Memorial Hospital, participates in the following Marketplace plans:

Blue Cross Blue Shield:

  • Blue Choice products (PPO)
  • Blue Precision products (HMO)

The Health Care Law

According to the Affordable Care Act, everyone who legally lives in the United States must have health insurance.

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.

What the Plans Cover

All plans include coverage for doctor visits, hospital stays, wellness care, prescriptions, emergency services and more. In fact, there are 10 essential health benefits that are included 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.

See what preventive care must be covered by the plans.

Open Enrollment

If you do not have health insurance, you must sign up for coverage during open enrollment, which takes place once a year, usually in the fall. For example, open enrollment for 2018 insurance was November 1–December 15, 2017. You can shop for plans by phone, through a broker or at the online Marketplace, where you can compare benefits and costs easily. Those who do not sign up will face a penalty.

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

There are several ways to sign up or learn about your options:

  • Online: Shop for coverage at GetCoveredIllinois.gov.
  • Online outside Illinois: Shop for coverage at Healthcare.gov.
  • Phone: For help choosing a plan and enrolling, call 1-800-318-2596 toll free

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.

About Charity Care

If you currently receive services through "charity care," you should sign up for health coverage. With health insurance, you will be covered for things like doctors' visits and prescription medicines, which are not covered now – and may not be covered when your charity care coverage ends.

How to Renew Your Marketplace Health Insurance Plan

During the Open Enrollment Period, individuals can purchase health insurance plans. If you already have health insurance, the open enrollment is the time to shop for new Marketplace coverage or decide to stay in the same, or a similar, plan. Open enrollment takes place once a year, usually in the fall. For example, for 2018 insurance, the Marketplace Open Enrollment period was November 1–December 15, 2017.

When open enrollment begins, your health insurance company will send a letter to let you know if your plan is still being offered and how the plan is changing. Before open enrollment ends, check to be sure the insurance plan works for you, that the doctors and hospitals you use and prescription drugs you need are still in-network. If you need help reviewing whether your plan is right for you, call 1-800-827-9832. In most cases, if you do not take action, your health insurance company will automatically enroll you in the plan you currently have or the one most similar to it if your plan is no longer available.

During the open enrollment period, you can:

  • Update your application information.
  • See if you qualify for new or different help paying for your premiums and out-of-pocket costs.
  • Compare available plans.
  • Enroll in a plan that meets your needs.

Loyola Medicine participates in the following Marketplace plans:

Blue Cross Blue Shield:

  • Blue Choice products (PPO)
  • Blue Precision products (HMO)

For more information, you also may visit HealthCare.gov/keep-or-change-plan. TTY users should call 1-855-889-4325.

You May Qualify for Financial Assistance Paying for Insurance

Financial Assistance

A surprisingly large number of people qualify for financial help when buying health insurance through the Marketplace.

For example, someone who earns up to $48,240 a year, or a family of four earning up to $98,400 a year, qualifies for reduced monthly premiums or a tax credit at the end of the year. Visit the Marketplace website's Income Level & Savings page to find out whether you qualify and how much assistance you could get.

Financial Assistance Calculator

The Kaiser Family Foundation provides a detailed subsidy calculator that can weigh different incomes, ages and family sizes. It also can help you see whether you may qualify for Medicaid, too.

Where to Go for Help Choosing, Renewing or Enrolling in Health Insurance

  • GetCoveredIllinois.gov – The Illinois health insurance marketplace site allows you to access healthcare plans to compare, enroll or change coverage. It provides information on enrolling online, comparing plans and making an appointment for a one-on-one in-person help.
  • Healthcare.gov – The federal government website provides links to the health insurance exchanges offered across the country as well as information about the Affordable Care Act, eligibility, Medicare and Medicaid.
  • 1-800-318-2596, HealthCare.gov toll-free number – This 24-hour-a-day, 7-day-a-week help desk answers questions about signing up for insurance and Medicaid, shopping for insurance plans and finding an informational event.