AFFORDABLE CARE ACT FACTS: What Benefits Are Covered, Is Your Doctor In the Network?

By  //  November 13, 2016

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SEE IMPORTANT FACTS, THEN CHOOSE A PLAN BY JAN. 31

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All Health First Health Plans feature great benefits at no extra cost including gym memberships at Health First Pro-Health & Fitness Centers and 8,500 Healthways Prime locations nationwide. CLICK HERE NOW TO ENROLL

EDITOR’S NOTE: To assist you to better understand the Affordable Care Act and what it means to you and your family, Space Coast Daily is featuring a series of informational Q&A format posts. If you need health coverage and want to avoid the fee for 2017, enroll in a plan by January 31. This informative series is sponsored by Health First Individual, which provides health insurance for individuals and families with access to more than 4,000 providers.

If You Need Health Coverage and Want To Avoid the Fee For 2017, CLICK HERE To Enroll In a Plan By January 31

Q: What health benefits are covered under Marketplace plans?

A: All qualified health plans offered in the Marketplace will cover essential health benefits. Categories of essential health benefits include:

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• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including dental and vision care

The precise details of what is covered within these categories may vary somewhat from plan to plan.

Q: How can I find out if my doctor is in a health plan’s network?

A: Each plan sold in the Marketplace must provide a link on the Marketplace web site to its health provider directory so consumers can find out if their health providers are included.

The provider network information that insurance companies provide should tell you whether a provider is accepting new patients, or whether a provider speaks your language.

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Q: Can I be charged more because of my age?

A: Yes, in most states you can, within limits. This limit on age rating applies to all non-group and small-group health insurance policies, whether sold in the Marketplace or outside of the Marketplace.

Q: Can I be charged more because I smoke?

A: Yes, in most states you can. Insurers are allowed to increase premiums by up to 50% more for people who use tobacco, although many insurers apply a lower surcharge for tobacco use. If you qualify for premium tax credits, this tobacco surcharge will not be covered by the tax credit. States are allowed to limit tobacco surcharges and a few have decided to prohibit tobacco rating by health insurers. The average additional cost is about 20%.

If You Need Health Coverage and Want To Avoid the Fee For 2017, CLICK HERE To Enroll In a Plan By January 31

Q: I’m a young adult and I need health insurance. What are my coverage options?

A: A number of options may be available to you:

• If your taxable income is below 138% of the federal poverty level ($16,394 for a single person in 2017), you may qualify for Medicaid coverage. Not all states have elected to expand Medicaid eligibility to this income level. Check with your state Marketplace to find out more about Medicaid eligibility in your state.
• If your parents have health insurance that offers dependent coverage, you can join (or stay on) their policy as a dependent and remain covered until your 26th birthday. See below for more information about dependent coverage for young adults.
• You can buy a policy on your own through your state health insurance Marketplace. All plans sold through the Marketplace must meet requirements for covered benefits and cost sharing. Depending on your income, you may be eligible for help to reduce the cost of plan premiums and/or cost sharing.
• Special, catastrophic policies with very high cost sharing must be offered to young adults under the age of 30. Premium and cost sharing subsidies are not available for catastrophic plans.
• If you are a student, you may be able to enroll in student health offered through your college or university.

CLICK HERE FOR MORE INFORMATION

– Source: Kaiser Family Foundation

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All Health First Health Plans feature great benefits at no extra cost including gym memberships at Health First Pro-Health & Fitness Centers and 8,500 Healthways Prime locations nationwide. CLICK HERE NOW TO ENROLL


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