A Quick Guide to the Health Insurance Marketplace What you need to know when applying for health coverage
5 Steps to Stay Covered Through The Marketplace 2015 Essential Health Benefit Coverage
Find out what services are covered under the marketplace health plans
Living Well Through Awareness By Cathy Nedd Chief Operating Officer Michigan Chronicle
Welcome to Living Well. Recognized as the single most credible source of fitness, health and nutrition information for African Americans, each edition is crafted to provide insight into health disparities impacting African Americans and methods on prevention and treatment. There is a growing need for health awareness in our community. The mission of Living Well is to provide our readers with a wealth of information that enables them to live healthier and happier lives. In these pages you’ll find content on health issues, healthy lifestyles and relatable personal stories from people in our community. November 15th marked the beginning of open enrollment for healthcare in the Marketplace. It is important to make sure you and your family has health coverage. This month’s Living Well includes resources and information on essential health benefits, qualifying coverage, fees, exemptions and local help. Living Well isn’t just words on a page, it’s a lifestyle and the Michigan Chronicle takes pride in helping lead the way. Be healthy and live well.
Table of Contents
P3 P4 P6 P7
|
A Quick Guide to the Health Insurance Marketplace
| Essential Health Benefit Coverage 5 Steps to Staying Covered Through the | Marketplace
| How Much is your Small Business Health Care Tax Credit Worth?
Publisher | Hiram E. Jackson Managing Editor | Tatiana Jackson Graphic Designer | Juan Sifuentes
Quick Facts to the Health Insurance Marketplace: • All private health insurance plans offered in the Marketplace offer the same set of essential health benefits • Most people in the United States must have health coverage or pay a fee. If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child) — whichever is higher. • Under certain circumstances, individuals won’t have to pay the fee (also known as “the penalty”, “individual shared responsibility payment”, or “the individual mandate.” • When you apply for premium tax credits and other savings in the Marketplace, you’ll need to estimate your income for 2015. You’ll provide this information on your Marketplace application.
2 LivingWELL • November 2014
A Quick Guide to the Health Insurance Marketplace Courtesy of healthcare.gov
O
pen enrollment in to the Health Insurance Marketplace began on November 15, 2014. Here are some steps to make sure you know how to navigate through the enrollment process. You can preview 2015 plans and prices before you apply by visiting www.healthcare.gov/ see-plans/ . Simply enter your zip code to view plans in your area.
able in 2015 and will change at all? See how to look up your plan. The Marketplace can’t enroll you automatically for 2015. If this applies to you, your Marketplace notice will explain what to do next. You’ll need to enroll in a plan by December 15, 2014, for your coverage to start January 1, 2015.
If you bought a health insurance plan through the Marketplace in 2014, you can renew your current plan or enroll in a different plan for 2015. If you do not choose a plan during open enrollment you’ll probably be automatically enrolled in your current plan or a similar plan. You can change to a new plan for 2015 even if you are automatically enrolled. Your 2015 health coverage choices You should get two important notices about your health coverage. One will come from your health insurance company. One will come from the Marketplace. These notices help you understand your choices for 2015, so it’s important to review them carefully and keep them in a safe place. Learn more about these notices. If you have 2014 Marketplace coverage, your notices will explain which one of these will apply to you: The Marketplace will re-enroll you automatically in your 2014 plan or enroll you in a similar plan. This means that even if you don’t do anything your 2015 coverage will renew on January 1, 2015. But you must update your income and household information as soon as possible to be sure you get the right plan choices and amount of savings for 2015. Want to know if your 2014 plan will be availLivingWELL • November 2014 3
Find local he p
Essential Health Benefit Coverage
For your convenience, here is a list of agencies to contact with questions or concerns regarding enrollment for health coverage.
All private health insurance plans offered in the Marketplace offer the same set of essential health benefits. Following are services all plans must cover: •Ambulatory patient services (outpatient care you get without being admitted to a hospital) •Emergency services •Hospitalization (such as surgery) •Pregnancy, maternity, and newborn care (care before and after your baby is born) •Mental health and substance use disorder services, 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 and chronic disease management •Pediatric services Additional benefits Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace. Additional benefits include: •Birth control benefits •Breastfeeding benefits •Dental coverage
Detroit Health Care For The Homeless dba Advantage Health Centers Phone: (313) 835-5990 Email: administration@advantagehealthcenters.org Web: http://ahcdetroit.org Address: 79 West Alexandrine, Third Floor Detroit, MI 48201 Wayne State University Physician Group Phone: (248) 581-5840 Email: financialcounselors@wsupgdocs.org Web: http://www.wsupgdocs.org Address: 3990 John R Detroit, MI 48201 Wellness Plan Phone: (313) 875-4200 Email: cherrell@wellplan.com Web: http://wellplan.com Address: 21040 Greenfield Oak Park, MI 48237 PhysioFlex, PLLC. Phone: (248) 440- 7102 Email: tjones.physioflex@yahoo.com Address: 26250 Northwestern Highway Southfield, MI 48075 Covenant Community Care, Inc. Phone: (313) 554- 0485 Email: jpettway@convenantcommunitycare.org Web: http://www.convenantcommunitycare.org Address: 20901 Moross Road Detroit, MI 48236 Small businesses and their employees can get help from the toll-free SHOP Marketplace call center Phone: 1-800-706-7893 or for TTY, call 711.
Important dates and deadlines Nov. 15, 2014: Open enrollment starts. This is the first day you can apply for 2015 coverage Dec. 15, 2014: The last date to enroll for coverage that starts January 1, 2015 Dec. 31, 2014: Date when all 2014 Marketplace coverage ends, no matter when you enrolled Jan. 1, 2015: The date 2015 coverage can start if you apply by Dec. 15, 2014, or if you accept automatic enrollment in your 2014 plan or a similar plan Feb. 15, 2015: The last day to enroll in 2015 coverage. If you miss this deadline, you can’t sign up for a health plan inside or outside the Marketplace for the rest of 2015. The only exception is if you qualify for a special enrollment period.
More agencies can be found at localhelp.healthcare.gov
Special Enrollment Period In some cases, you may still be able to get coverage for the rest of 2014 with a Special Enrollment Period (SEP). This would allow you to sign up for coverage through the end of 2014 even though 2014 Open Enrollment ended March 31, 2014. Important: Any 2014 plan you enroll in with a Special Enrollment Period ends December 31, 2014. This is true no matter when your 2014 coverage starts. Getting covered for the rest of 2014 The following Special Enrollment Periods still apply for 2014: •Having a baby, adopting a child, or placing a child in foster care. If you have a baby, adopt a child, or place a child in foster care any time during 2014, you have up to 60 days after 4 LivingWELL • November 2014
the event to enroll in 2014 coverage. If you enroll within the 60-day period, the new coverage would start on the day of the birth, adoption, or placement in 2014. This is true even if you enroll in the 2014 coverage during 2015. •Marriage. If you get married on or before November 30, 2014, you can enroll in 2014 coverage that starts as early as December 1, 2014. If you get married December 1 or later, you should fill out the 2015 application. Your coverage can start as soon as January 1, 2015. •Losing other health coverage. If you lose a plan that qualifies as minimum essential coverage on or before November 30, 2014 due to job loss, an income increase that makes you no longer eligible for Medicaid, or similar circumstances,
you can enroll in a 2014 plan that starts December 1, 2014. In order to get 2014 coverage for the month of December you must select the plan on or before November 30, 2014. If you select a plan after this date, your coverage will start as soon as January 1, 2015. In this case, you should complete the 2015 application. Important: If you leave your job for any reason and lose your job-based health coverage when you do, you qualify for a Special Enrollment Period. But if you voluntarily drop an individual insurance plan, or drop a job-based plan without leaving your job, you don’t qualify for an SEP.
Qualifying Coverage, Fees and Exemptions Courtesy of healthcare.gov
M
ost people in the United States must have Hardship exemptions health coverage or pay a fee. Plans that count If any of the following circumstances apply, as coverage to avoid penalty include: individuals may qualify for a hardship exemp• Any Marketplace plan or any individual insurance tion from the penalty: plan you already have • You were homeless • Any employer plan (including COBRA plans, with • You were evicted in the past six or without “grandfathered” status) months or were facing eviction • Retiree health plans or foreclosure • Medicare • You received a shut-off notice from • Medicaid a utility company • The Children’s Health Insurance Program (CHIP) • You recently experienced domestic violence • TRICARE (for current service members and • You recently experienced the death of a close military retirees, their families, and survivors) family member • Veterans health care programs (including the • You experienced a fire, flood or other natural or Veterans Health Care Program, VA Civilian Health human-caused disaster that caused and Medical Program (CHAMPVA), and Spina substantial damage to your property Bifida Health Care Benefits Program) • You filed for bankruptcy in the last six months • Peace Corps Volunteer plans • You had medical expenses you couldn’t pay in • Self-funded health coverage offered to students the last 24 months that resulted in substantial debt by universities for plan or policy years that begin • You experienced unexpected increases in on or before Dec. 31, 2014 necessary expenses due to caring for an ill, disabled or aging family member Other plans may qualify. Ask your health coverage • You expect to claim a child as a tax dependent provider. who’s been denied coverage in Medicaid and CHIP, and another person is required by court Exemptions from the fee order to give medical support to the child. In this case, you don’t have the pay the penalty for the child. Under certain circumstances, individuals won’t have • As a result of an eligibility appeals decision, to pay the fee (also known as “the penalty,” “individual you’re eligible for enrollment in a qualified health shared responsibility payment” or “the individual manplan (QHP) through the Marketplace, lower costs date.” Exemptions from this payment include: on your monthly premiums, or cost-sharing • You’re uninsured for less than three months of the year reductions for a time period when you weren’t • The lowest-priced coverage available to you enrolled in a QHP through the Marketplace would cost more than 8 percent of your • You were determined ineligible for Medicaid household income because your state didn’t expand eligibility for • You don’t have to file a tax return because your Medicaid under the Affordable Care Act income is too low (Learn about the filing • Your individual insurance plan was cancelled and limit (PDF) you believe other Marketplace plans are • You’re a member of a federally recognized tribe or unaffordable eligible for services through an Indian •You experienced another hardship in obtaining Health Services provider health insurance • You’re a member of a recognized health care sharing ministry Applying for a hardship exemption • You’re a member of a recognized religious sect Hardship exemptions are usually provided for the with religious objections to insurance, including month before the hardship, the months of the hardship, Social Security and Medicare • You’re incarcerated (either detained or jailed), and and the month after the hardship. However, the Marketplace may provide the exemption for additional months not being held pending disposition of charges after the hardship, including up to a full calendar year. • You’re not lawfully present in the U.S. • You qualify for a hardship exemption
•For a hardship exemption based on affordability, the exemption will be granted for the remaining months in the coverage year. •For people ineligible for Medicaid only because a state hasn’t expanded Medicaid coverage, the hardship exemption will be granted for the whole calendar year. For people eligible for Indian Health Services, the hardship exemption will be granted on a continuing basis. It may be kept for future years without having to submit another application. This is true as long as there are no changes to your membership in a tribe or eligibility for services from an Indian health care provider. • Most people must have health coverage or pay a fee. If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child), whichever is higher. • You’re considered covered under the health care law if you have any job-based plan, any plan you bought yourself, Medicare, Medicaid, CHIP, and many other kinds of coverage. See a full list of plans and programs that meet the health law’s coverage requirement. Some people qualify for an exemption from the fee based on income or other situations. To apply for a hardship exemption, visit www.healthcare.gov.
LivingWELL • November 2014 5
STAYING COVERED THROUGH THE MARKETPLACE Now that you have health coverage through the Marketplace, it’s time to review your plan and decide if you need to make changes for 2015. Every fall, your health insurance company sends you a letter explaining changes to premiums and benefits for the coming year. You can choose to stay in your current plan (as long as it’s still offered) or make changes. If you don’t take action by December 15, 2014, you could miss out on better deals and cost savings.
REVIEW
PLANS CHANGE, PEOPLE CHANGE. Every year, insurance companies can make changes to premiums, cost-sharing, or the benefits and services they provide. Review your plan’s 2015 coverage to make sure it still meets your needs and you’re getting the best plan for you.
UPDATE
Starting November 15, visit HealthCare.gov and log into your Marketplace account. Answer a few questions to get to your 2015 application – it will be pre-filled with your latest information from 2014. Step through each page of your application and make changes if you need to. This is important – even if none of your information has changed, you might be eligible for lower costs than last year! You also can call the Marketplace Call Center at 1-800-318-2596 to review or make updates over the phone.
COMPARE
Log into your Marketplace account and follow the “Enroll To Do List” on HealthCare.gov to compare 2015 plan costs and benefits. New and more affordable plans may be available in your area this year. If you decide to stay in your current plan, follow the directions to search by that plan’s 14-digit ID – you can find the ID on the letter from your plan. Or, call the Marketplace Call Center at 1-800-318-2596 for help.
STEP 1 Review - Things to remember: # Look for a letter in the mail from your health plan describing any plan changes. # Read the letter, and contact your health plan if you have questions. # Write down important dates and information from the letter - like December 15, and your 14-digit plan ID.
STEP 2 Update - Things to consider: # Can’t access your Marketplace account? Follow the steps on the screen to reset your password.
CHOOSE
# Did any of your income, household, or personal information change? Even a small change can affect your premium tax credits and cost- sharing reductions, so make sure your information is up-to-date.
ENROLL
# After you submit your 2015 application, check your eligibility results carefully. Even if none of your information changed, you might get different cost savings because of changes in the Marketplace.
Choose a health plan for 2015. You can keep the same plan (as long as it’s still offered) or select a new one that better fits your needs. If you want to stay enrolled in your 2014 plan, use the plan ID in the letter you get from your health plan. Stay covered for 2015! Contact your plan to confirm your enrollment. Make sure to pay your premium.
STEP 3 Compare - When comparing plans, consider: # Are there more affordable plans available to you that weren’t an option last year? # Are you happy with the changes to your current plan? # Are your current doctors in the plan’s network? # Will your prescriptions be covered?
Complete all 5 Steps to finish enrolling in a health plan, even if you want to stay in the same plan. This is important to get the coverage you want and the most cost savings that you’re eligible for. If you don’t finish all of the steps by December 15, we’ll try to enroll you automatically so you stay covered. But this coverage might not be your best option for 2015 and you could miss out on cost savings. If you have questions or need to find someone who can help you in person, we can help. Find local help at:
# What will your benefits and costs be?
• Localhelp.healthcare.gov/
STEP 4 Choose - Things to remember:
• The Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855889-4325. The call is free.
# You can choose any plan available to you in your area in 2015, no matter what kind of coverage you had in 2014. # All 2015 Marketplace plans include all benefits and protections required by the health care law. # You can use any premium tax credits and costsharing reductions (if you qualify) only if you enroll in a plan through the Marketplace.
Tell them you need help with the 5 Steps.
STEP 5 Enroll - Things to remember: # For health coverage starting January 1, 2015, you must enroll in a plan by December 15, 2014. # If you want to change 2015 plans after December 15, 2014, you can do that any time during Open Enrollment, which continues through February 15, 2015. # If you make updates and enroll in a new health plan after December 15, 2014, your coverage won’t start on January 1. Read the notice from your health plan to check when your coverage will start.
CMS Product No.11857 October 2014
6 LivingWELL • November 2014
How much is your Small Business Health Care Tax Credit worth? Even if you’re a small employer who does not qualify for a small business tax credit, you may still purchase coverage through SHOP.”
Courtesy of healthcare.gov
Even if you’re a small employer who does not qualify for a small business tax credit, you may still purWhen you buy health coverage for your employees chase coverage through SHOP. through the Small Business Health Options Program (SHOP) Marketplace, you may qualify for a tax credit What’s new in the SHOP Marketplace for 2015 coverworth up to 50 percent of your premium contributions. age • As of Nov. 15, 2014, you are able to apply, The new Full-Time Equivalent (FTE) Calculator compare plans and enroll in a SHOP plan helps small employers determine if they are eligible online. to buy SHOP coverage for their employees, while the • Your employees will be able to enroll in your new SHOP Tax Credit Estimator lets small employers plan online too, making the process easier for learn the size of the tax credit they could get for conboth of you. tributing to coverage for their employees through the • In some states, you will be able to offer more SHOP. than one plan to your employees, thus Following are some key things you should know increasing their choices and letting them find a about the tax credit and applying for SHOP: health plan that works for them. See if your state will offer this option in 2015. • Employers with fewer than 25 full-time • Health insurance agents and brokers registered equivalent employees may be eligible for the with the SHOP Marketplace will have special Small Business Health Care Tax Credit, worth online features that make it easier for them to up to 50 percent of employer premiums help you apply, choose coverage, enroll, and contributions, if their employees make an manage your coverage, if you authorize them average of $50,000 a year or less. to help. • The tax credit will be available to eligible employers for two consecutive taxable years. When you are logged in to the new SHOP online • The tax credit may be available to eligible application, you’ll be able to search by zip code for tax-exempt employers who could receive up to agents or brokers registered with the SHOP Market35 percent of employer premium contributions, place. and can access the credit as a refund. • Generally, the Small Business Health Care Tax For more information call SHOP Small Employer Call Credit is available for eligible employers Center at 1-800-706-7893. Monday through Friday, 9 purchasing SHOP health plans. a.m. to 7 p.m. • Visit IRS.gov for the most up to date information and guidance on claiming this tax credit. LivingWELL • November 2014 7
Ask us anything about healthcare How and when can I get the new insurance plans? When can I enroll? How can I get help paying for my insurance and my healthcare? What’s changed? At Humana, we know there are a lot of healthcare questions out there. And that’s OK. We’re here to listen to you and explain your options. So you can find a plan that works for you and fits your budget. We’re going beyond insurance to become your partner in health. Give us a call at 1-888-840-7617 or go to HumanaHelpsDetroit.com
MIHJ42REN 1014
8 LivingWELL • November 2014