We know health insurance can be confusing. With so many terms and facts to know, it can be hard to keep it all straight. We give you fast, easy answers for the most common questions people have about individual health insurance plans.
What is the Individual Health Insurance Marketplace and how does it work?
The Individual Health Insurance Marketplace, often called the “Marketplace” or “Exchange,” is a resource for individuals and families to shop for and sign up for a health insurance plan. The Marketplace also provides information on programs that can help people pay for insurance coverage.
Every year during a period of time called open enrollment, qualified individuals can enroll in a health insurance plan or switch to a new plan.
Why do I need health insurance?
Health insurance helps you pay for the care you need to stay healthy, and it protects your finances in case something unexpected happens to your health. Having health insurance and choosing a primary care doctor are the best ways to keep you and your family healthy.
It’s also the law. Most people in the US must now have health coverage or pay a
penalty
What does health insurance cover?
Health insurance covers many different healthcare services. All private health insurance plans on the Marketplace are required to cover the same set of basic benefits:
- Preventive services and management of chronic diseases
- Outpatient care that you get without being admitted to the hospital
- Emergency care
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse services
- Prescriptions drugs
- Rehabilitation care (for disabilities, or recovery from illnesses and injuries)
- Lab services (like blood tests, X-rays and scans)
- Pediatric care, including dental and vision care (adults aren’t required to have dental and vision care, but they can get them if they want them)
What important dates do I need to know?
Every year during a period of time called open enrollment, qualified individuals can enroll in a health insurance plan or switch to a new plan.
- For coverage in 2016, Open Enrollment for the Individual Health Insurance Marketplace starts November 1, 2015 and lasts until January 31, 2016.
- If you enroll in a health insurance plan by December 15, 2015, your coverage will start on January 1, 2016.
- If you enroll after December 15, 2015 you’ll need to check your health insurance plan to see when your coverage starts.
How do I change or keep my health insurance plan from this year?
If you bought a health insurance plan on the Marketplace for 2015, it’s easy to change it or keep it.
If you want to change your health insurance plan, simply pick a new plan during open enrollment.
If you want to keep your plan, your health insurer may automatically enroll you in the same or a similar plan. You will want to review your 2016 health insurance plan, and update your financial information to see if you qualify for any cost savings in 2016.
If the health insurance plan you have is no longer available in 2016, your health insurance company may automatically enroll you in a different plan. Just be careful that your new health insurance plan includes the doctors and hospitals you want to get care from.
Carolinas HealthCare System is here to help. We’re available to answer your health insurance questions from 8 a.m. to 9 p.m., Monday through Friday and 9 a.m. to 5 p.m. on Saturdays. We can help you find the right health insurance plan for you.
TERMS TO KNOW
Premium – The amount you pay each month to keep your health insurance plan active.
Out-of-pocket costs – Your total expenses for medical care that are not paid by your health insurance plan.
