Friday, September 27, 2013

Open enrollment in healthcare exchanges starting next week...

Despite the many, and increasingly desperate, efforts of Congressional Republicans to stop it, enrollment in state-based health insurance exchanges created as part of the Affordable Care Act starts October 1st.

There are still many questions about the exchanges and the process of enrolling in them.

Courtesy, some answers to some questions (more information at each link) -

What is the Health Insurance Marketplace?

The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.

With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll.

-- Arizona-specific information:

Health Insurance Marketplace in Arizona

If you live in Arizona, you’ll use this website,, to apply for coverage, compare plans, and enroll. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.

How do I get help enrolling in the Marketplace?

The Marketplace will offer several kinds of assistance to help you apply for coverage and choose a plan that meets your needs.
  • online questions and answers
  • online chat — available now
  • a toll-free call center—available now
  • people in your community trained to help you apply and enroll

Find local help

In all states, there will be people trained and certified to help you understand your health coverage options and enroll in a plan. They will be known by different names, depending on who provides the service and where they are located. All will provide similar kinds of help:
  • Navigators
  • Application assisters
  • Certified application counselors
  • Government agencies, such as State Medicaid and Children’s Health Insurance Program (CHIP) Offices
Insurance agents and brokers can also help you with your application and choices.

-- Find help in your area at


What if I have job-based insurance?

If you have job-based health insurance you like, you can keep it. You're considered covered. You may be able to change to Marketplace coverage if you want to.

Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014. If you'd like to explore Marketplace coverage options you can, but there are several important things to consider.

How can I get lower costs on Marketplace coverage?

When you use the Health Insurance Marketplace you may be able to get lower costs on monthly premiums or out-of-pocket costs, or get free or low-cost coverage.

3 ways to save on health care coverage

You can save money in the Health Insurance Marketplace 3 ways. All of them depend on your income and family size.
  1. You may be able to lower costs on your monthly premiums when you enroll in a private health insurance plan. These plans all cover essential health benefits and pre-existing conditions.
  2. You may qualify for lower out-of-pocket costs for copayments, coinsurance, and deductibles.
  3. You or your child may get free or low-cost coverage through Medicaid or the Children's Health Insurance Program CHIP. Some states will be expanding Medicaid eligibility in 2014, so you may qualify even if you have been turned down for Medicaid in the past.

What do small businesses need to know?

Small businesses may get health coverage in the Small Business Health Options Program (SHOP) Marketplace. No employers are required to offer health coverage.

Starting in 2014, businesses with 50 or fewer full-time equivalent (FTE) employees can use SHOP to offer coverage to their employees. This applies to non-profit organizations as well. You control the coverage you offer and how much you pay toward premium costs.

Health coverage through SHOP starts as soon as January 1, 2014. Open enrollment begins October 1, 2013. You can sign up and begin offering coverage any time during the year.

Do I qualify for Medicaid?

You qualify for Medicaid based on income and family size. If you're eligible, you get free or low-cost care and don't need to buy a Marketplace plan.

Medicaid basics

Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid programs must follow federal guidelines, but they vary somewhat from state to state.

== AHCCCS eligibility requirements here.

What if I'm self-employed?

If you're self-employed with no employees, you're not considered an employer. You can use the individual Marketplace to find coverage that fits your needs.

How to know if you’re "self-employed"

If you run an income-generating business with no employees, then you're considered self-employed (not an employer) and can get coverage through the Marketplace. You’re not considered an employer even if you hire independent contractors to do some work.
If you have employees (generally, workers whose income you report on a W-2 at the end of the year) you’re considered an employer. Then you could get coverage for yourself and your employees through the SHOP Marketplace. Learn more about how to determine if you have employees.

New options for the self-employed

If you're self-employed, you'll have more health coverage options in 2014.

Starting October 1, 2013, you can use the Marketplace to find health coverage that fits your budget and meets your needs. You can compare important features of several plans side-by-side, all of them offering a full package of essential health benefits. You can see what your premium, deductibles, and out-of-pocket costs will be before you decide to enroll.

You can't be denied coverage or charged more because you have a pre-existing health condition.
If you currently have individual insurance--a plan you bought yourself, not the kind you get through an employer--you may be able to change to a Marketplace plan. Learn more about changing individual insurance plans.

What if I have a pre-existing health condition?

Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition. (Emphasis added here)

How does the health care law protect me?

 Part 1.

Rights & Protections

Part 2.

The Health Insurance Marketplace

Part 3.

Coverage for Pre-Existing Conditions

Part 4.

Summary of Benefits and Coverage

Part 5.

Cracking Down on Frivolous Cancellations

Part 6.

Doctor Choice & Emergency Room Access

Part 7.

Young Adult Coverage

Part 8.

Free Preventive Care

Part 9.

Ending Lifetime & Yearly Limits

Part 10.

Rate Review & the 80/20 Rule

Part 11.

Your Right to Appeal Coverage Decisions

And if you were wondering about the section on death panels?  There isn't one, because they don't exist outside of the Koch-fueled fantasies of certain Republicans.

1 comment:

cpmaz said...

Previous comment deleted because it was spam.