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Prepared by the American Association of Colleges of Nursing

Assisting Your Patients: Navigating The Health Insurance Marketplace. Prepared by the American Association of Colleges of Nursing. What is the Health Insurance Marketplace?.

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Prepared by the American Association of Colleges of Nursing

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  1. Assisting Your Patients: Navigating The Health Insurance Marketplace Prepared by the American Association of Colleges of Nursing

  2. What is the Health Insurance Marketplace? • The Health Insurance Marketplace was created through the Patient Protection and Affordable Care Act or ACA [Public Law 111-148] specifically in relation to Subtitle D—Available Coverage Choices for All Americans. • It includes the Individual Mandate and the State Exchange. • Individual Mandate requires most individuals to obtain health insurance or pay a penalty in the form of a tax. • On June 28, 2012, the United States Supreme Court upheld this provision of the ACA as constitutional in a 5-4 decision. • State Exchanges allows for each state to decide if they will create their own exchange, partner with the federal government, or have a federally-facilitated exchange for individuals to gain coverage. Kaiser Family Foundation (2014). State Decisions For Creating Health Insurance Marketplaces, 2014 Retrieved from http://kff.org/health-reform/state-indicator/health-insurance-exchanges/

  3. Fielding Your Patient’s Basic Questions About The Marketplace

  4. Am I eligible? • For an individual to be eligible for coverage through the Marketplace, they must meet the following criteria: • Live in the United States • Be a U.S. citizen, national, or live lawfully in the United States • Cannot be incarcerated Healthcare.gov. (2014) Am I eligible for coverage in the Marketplace, Retrieved from https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace/

  5. What Are The Essential Health Benefits? • Essential Health Benefits: A set of health care service categories that must be covered by certain plans, starting in 2014. • Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. • States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid. Healthcare.gov. (2014) Glossary: Essential Health Benefits, Retrieved from https://www.healthcare.gov/glossary/essential-health-benefits/

  6. What Are The Essential Health Benefits? (continued) • Services and devices that assist in recovery if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more. • Preventive services including counseling, screenings, vaccines, and care for managing a chronic disease. • Pediatric services: This includes dental care and vision care for kids • Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers.1 • These essential health benefits include at least the following items and services: • Outpatient care • Emergency room visits • Inpatient hospital treatment • Prenatal and postnatal care • Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy • Prescription drugs • Lab tests Healthcare.gov. (2014) Glossary: Essential Health Benefits, Retrieved from https://www.healthcare.gov/glossary/essential-health-benefits/

  7. What Will I Need to Enroll? • Social Security Numbers (or document numbers for legal immigrants) • Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2forms—Wage and Tax Statements • Policy numbers for any current health insurance plans covering members of your household • A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible • A Check List was created to help individuals with the enrollment process Healthcare.gov. (2014) Marketplace Application Checklist, Retrieved from https://www.healthcare.gov/downloads/MarketplaceApp_Checklist_Generic.pdf

  8. How Can I Enroll: Apply on Line Provide the following steps to help an individual or family obtain coverage: • Create an account. Go to the Marketplace and select your state to begin. Provide some basic information, and then choose a user name, password, and security questions for added protection. • https://www.healthcare.gov/marketplace/individual/ • Complete your application. Provide information about you and your family, like income, household members, current health coverage, and more. Use this checklist to gather the documents you’ll need. • Pick a plan. See all the options you qualify for, including Medicaid and the Children’s Health Insurance Program (CHIP). The system will you know if you qualify for lowers costs on private health coverage. Find out how to choose a plan that’s right for you. • Enroll. After you choose a plan, don't forget to enroll online and contact your insurance company to pay your first premium by the due date. Healthcare.gov (2014). Get Covered: A one-page guide to the Health Insurance Marketplace, Retrieved from https://www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace/.

  9. How Can I Enroll: Other Options • Apply by phone • Call 1-800-318-2596, 24 hours a day, 7 days a week (TTY: 1-855-889-4325). A customer service representative will work with you to complete the application and enrollment process. • Apply by mail • Fill out a paper application and mail it in. Once you get your eligibility notice, go online or contact our call center to pick a plan and enroll. Download the application form and instructions to begin • Local resources • You may be able to apply online at a local library or at a Community Health Center in your area.

  10. When Does The 2014 Enrollment End and When Will Be The Next Enrollment? During open enrollment, if your patient enrolls Between the 1st and 15th days of the month, their coverage starts the first day of the next month. Between the 16th and the last day of the month, their coverage starts the first day of the second following month. So if they enroll on March 16, your coverage starts on May 1. Healthcare.gov. (2014). What key dates do I need to know? Retrieved from, https://www.healthcare.gov/what-key-dates-do-i-need-to-know/#part=2.

  11. How Do I Find Out What My State Is Offering? • Regardless of the state where you live, you can access the Marketplace to apply for coverage, compare your options, and enroll.

  12. What Is Meant By The Tax Credit? • When you buy health insurance coverage in the Marketplace, you may qualify to receive a premium tax credit that lowers what you pay in monthly premiums. This premium will is dependent upon household income and size. • To find out if you qualify for a tax premium, visit: https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/. Here, you will be asked questions about your household which will determine if you qualify and the premium amount.

  13. Directing Patients To Additional Resources on the Marketplace

  14. Where Can I Direct My Patients Who Have Questions I Cannot Answer?

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