FAQ

When can I enroll?

Open Enrollment runs from November 1 through December 15^th of each year. If you enroll in a plan before the 15^th of the month, the plan will be effective on the 1^st of the following month. If you enroll in a plan after the 15^th of the month, the plan will be effective on the 1^st of the second following month. So, in order to have your coverage start January 1^st, you will need to enroll before December 15.

How can I get help with enrollment?

Agents and Navigators are available to assist people in enrolling in plans on the Health Insurance Marketplace, however there are some pretty big differences between Agents and Navigators. Agents are licensed by the state’s Department of Insurance, which requires that they complete a background check, an extensive knowledge test regarding health insurance, and annual continuing education. In order to enroll people on the Health Insurance Marketplace, Agents complete annual training on the Health Insurance Marketplace, as well as training with each individual insurance company on the plans they are offering and their networks. Navigators are only required to complete annual training on the Health Insurance Marketplace in order to help people enroll. They are not required to complete a background check, a health insurance knowledge test, continuing education, or training regarding the specific plans and networks offered on the Health Insurance Marketplace.

How does the ACA make healthcare affordable?

The Affordable Care Act (ACA) provides tax credits to individuals and families to help them pay for their health insurance. Tax credits are based on household size and income for all members of the household, even if they don’t all need coverage. Instead of getting your tax credit when you file your 2016 income taxes, you have the option of getting them sent directly to the insurance company in advance to help pay your monthly premium. This lowers the monthly cost of insurance and helps make it affordable for everyone. In order to get the tax credit, you must enroll in a plan offered on the Health Insurance Marketplace.

What plans do you offer?

There are four different companies offering health coverage through the Health Insurance Marketplace for 2016. These are Blue Cross Blue Shield, BlueChoice (a licensee of BCBS), Aetna/Coventry, and United Healthcare. Each of these companies have different networks of hospitals and doctors, and most have certain network restrictions. All fof these companies offer Bronze, Silver, and Gold plans, and all plans include coverage for the 10 Essential Health Benefits. Plans do not typically cover dental and vision services for adults; however for 2016 Blue Cross and BlueChoice are including basic dental and vision coverage in all of their plans.

What do the plans cover?

The Affordable Care Act requires that all health plans on the Health Insurance Marketplace cover 10 Essential Benefits. The essential health benefits include at least the following items and services:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (such as surgery)
• Preganancy, maternity, and newborn care(care before and after your baby is born)
• Mental health and substance use disorders, including behavioral health treatment (this includes counseling and psychotherapy)
• 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, including chronic disease management
• Pediatric services, including pediatric dental and vision