Frequently Asked ACA Open Enrollment Questions

20 Nov Frequently Asked ACA Open Enrollment Questions

Posted at 18:53h in Affordable Care Act by Greg Peters 0 Comments

It’s a busy time of year here at the Exact Insure office! With healthcare Open Enrollment, there are many questions to be answered. While we love talking to each of our clients individually, we thought that many people out in the internet sphere might benefit from a quick list of frequently asked questions. So, here goes…

FAQ: Am I eligible for a government subsidy to help offset the cost of my healthcare plan?

Answer: Your eligibility will depend on your specific circumstances. To determine whether you qualify for a subsidy, and how much it is, simply click on this link, provided by the Kaiser Family Foundation.

FAQ: What is considered “minimum essential coverage”?

Answer: The following ten essential health benefits have been included under the law:

Ambulatory patient services
Emergency services
Hospitalization
Laboratory services
Maternity and newborn care
Mental health and substance abuse disorder services (including behavioral health treatment)
Pediatric services, including oral and vision care
Prescription drugs
Preventive and wellness services and chronic disease management
Rehabilitative and habilitative services and devices

FAQ: I do not expect to require maternity and newborn care, or pediatric services. Do I still have to pay for them?

Answer: The law requires that every individual on an ACA healthcare plan be covered for these services. So, yes, an unmarried man with no children must pay for maternity and pediatric care. Likewise, a woman beyond her childbearing years will pay for the coverage as well.

FAQ: My healthcare plan is being transitioned to a different plan, with a narrow hospital and doctor’s network in 2015. What are my options?

Answer: Some insurance companies have elected to move to very narrow networks for 2015 in order to keep their costs low. However, many insurance companies continue to offer more robust networks, which you can still take advantage of. To ensure that your chosen plan is in effect on the plan start date of January 1, you will want to make your changes by December 15th. If you make changes from December 16th to January 15th, they will be effective February 1st, and if you make them January 16th to February 15th, they will go into effect on March 1st. After February 15th, no changes can be made. (Though the government reserves the right to change and extend that date if they deem it necessary.)

Maintaining your existing network will be especially important to those individuals who see specialists or have complicated medical histories, with an established doctor-patient relationship. You may also want to consider that, as insurance companies move to narrow networks, the doctors within those networks are likely to see an extreme increase in volume, which may lead to scheduling difficulties and longer wait times.

You’ve Got Questions, We’ve Got Answers

At Exact Insure, our business is helping YOU, our client, wade through the red tape and confusion of these healthcare changes. Contact us today so that we can answer your questions and ensure that you elect the healthcare plan that is right for you. We are licensed and experienced in the states of Indiana and Kentucky.