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. 

Open enrollment in the Health Insurance Marketplace began November 1 and continues through January 31, 2017.

Whether you are getting insurance for the first time or changing insurance plans, you must enroll in a plan by December 15, 2016, for coverage in your new plan to start on January 1, 2017.

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.

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 University Health System so you'll always have the latest treatment options, leading-edge technology and the region's top-rated and most experienced physicians.

Loyola University Health System, 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)
  • Blue Cross Multi-state products

Humana:

  • Chicago HMOx (offered in limited counties in Illinois)

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 the detailed list of preventive care covered.

Open Enrollment Through January 31, 2017

If you do not have health insurance, you must sign up for 2017 coverage during open enrollment, from now to January 31, 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

Remember, you must enroll in a plan by December 15, 2016, for coverage in your new plan to start on January 1, 2017.

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, it is the time for you to shop for new Marketplace coverage or decide to stay in the same, or a similar, plan. This year, the Marketplace Open Enrollment Period is from November 1, 2016, through January 31, 2017.

Your health insurance company will send you a letter by November 1, 2016, to let you know if your plan is still being offered and how the plan is changing.

If your health insurance company will offer a plan in your area for 2017: The letter you get from your health insurance company will tell you the new monthly premium amount and any changes to the plan. If you have questions about plan benefits, which providers are in-network, or how to pay your premiums, call your health insurance company directly.

If your health insurance company won't offer a plan in your area for 2017: Your health insurance company may decide to stop offering certain plans next year. If your health insurance company won't offer a plan in your area for 2017, then you'll need to choose a new plan for 2017 to continue having coverage.

Call 1-800-827-9832 to make sure your current plan is still right for you.* Be sure that the plan works for you, that the doctors and hospitals you use and prescription drugs you need are still in-network. 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.

From November 1, 2016 to January 31, 2017, 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.

Remember, you must enroll in a plan by December 15, 2016, for coverage in your new plan to start on January 1, 2017.

Loyola University Health System participates in the following Marketplace plans:

Blue Cross Blue Shield:

  • Blue Choice products (PPO)
  • Blue Precision products (HMO)
  • Blue Cross Multi-state products

Humana:

  • Chicago HMOx (offered in limited counties in Illinois)

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 $47,520 a year, or a family of four earning up to $97,200 a year, qualifies for reduced monthly premiums or a tax credit at the end of the year.

A few useful financial calculators can help you estimate how much assistance you may obtain — before you even visit the Marketplace website. However, only the Marketplace will let you know the exact assistance you can expect. 

Financial Assistance Calculator

For a simple calculator, visit getcoveredamerica.org/calculator/.

The Kaiser Family Foundation provides a more 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.

Preventive Care Services

All marketplace plans must cover the following list of preventive services without charging 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 Men and Women

  • Abdominal aortic aneurysm one-time screening
  • Alcohol misuse screening and counseling
  • Aspirin use
  • Blood pressure screening
  • Cholesterol screening
  • Colorectal cancer screening
  • Depression screening
  • Diabetes (Type 2) screening
  • Diet counseling
  • HIV screening
  • Vaccines and immunizations
  • Obesity screening and counseling
  • Sexually transmitted infection (STI) prevention counseling
  • Syphilis screening
  • Tobacco use screening

 

Preventive Screenings For Women

  • Anemia screening
  • Breast cancer genetic test counseling (BRCA)
  • Breast cancer mammography screenings
  • Breast cancer chemoprevention counseling
  • Breastfeeding comprehensive support and counseling
  • Cervical cancer screening
  • Chlamydia infection screening
  • Contraception
  • Domestic and interpersonal violence screening and counseling
  • Folic acid supplements
  • Gestational diabetes screening
  • Gonorrhea screening
  • Hepatitis B screening
  • HIV screening and counseling
  • Human papillomavirus (HPV) test
  • Osteoporosis screening
  • Rh incompatibility screening
  • Sexually transmitted infection (STI) counseling
  • Syphilis screening
  • Tobacco use screening and interventions
  • Urinary tract or other infection screening
  • Well-woman visits

 

Preventive Screenings For Children

  • Alcohol and drug use assessments for adolescents
  • Autism screening
  • Behavioral assessments
  • Blood pressure screening
  • Cervical dysplasia screening
  • Depression screening
  • Developmental screening
  • Dyslipidemia screening
  • Fluoride chemoprevention supplements
  • Gonorrhea-preventive medication
  • Hearing screening
  • Height, weight and body mass index measurements
  • Hematocrit or hemoglobin screening
  • Hemoglobinopathies or sickle cell screening
  • HIV screening
  • Hypothyroidism screening
  • Immunization vaccines
  • Iron supplements
  • Lead screening
  • Medical history
  • Obesity screening and counseling
  • Oral health risk assessment
  • Phenylketonuria (PKU) screening
  • Sexually transmitted infection (STI) prevention counseling and screening
  • Tuberculin testing
  • 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. Here are the essential benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Source: Healthcare.gov