Open enrollment to purchase coverage from the health insurance marketplace is set to begin November 1, 2018 and end on December 15, 2018.
Following are answers to your most frequently asked questions about the coverage available through healthcare.gov and the state exchanges created by the Affordable Care Act (ACA).
What is the health insurance marketplace and how do I know if I am eligible for coverage?
The health insurance exchange, also called a health insurance marketplace, is where consumers can go to purchase health insurance. Under the Affordable Care Act, most Americans are required to have health insurance or face a financial penalty when filing their taxes.
Americans without coverage through Medicare or their employer are likely eligible to purchase coverage through the health insurance exchange. In fact, many people will also qualify for financial assistance from the federal government to help pay for this coverage. That assistance can dramatically reduce monthly premiums and, for certain consumers, their out-of-pocket expenses as well. In order to find out if you are eligible for assistance, visit www.healthcare.gov.
How do I enroll in coverage?
Regardless of how your state has chosen to organize the marketplace in your state, the best starting place is www.healthcare.gov. This website is hosted by the federal government and serves as the entry point for consumers who want to purchase health insurance coverage through the exchange. If you live in a state with its own exchange, healthcare.gov will transfer you to the website for that state’s exchange.
The exchange sites will calculate based on your income whether you qualify for financial assistance to help pay for your coverage or for Medicaid benefits.
When is open enrollment?
Open enrollment is the period during which consumers select their insurance plan for the following calendar year. For health insurance coverage that would be effective for 2019, the open enrollment period begins on November 1, 2018 and runs through December 15, 2018.
Can I be denied coverage based upon my cancer diagnosis?
No. According to the Affordable Care Act, you cannot be denied coverage or charged a higher premium for your coverage due to any pre-existing condition, including cancer.
How many insurance choices will I have?
This will vary depending upon what state you live in. In some states, there may be multiple insurance companies offering a variety of plans. In other states, there may only be one or two companies offering plans.
The choices will be broken down into four 'metal tiers': bronze, silver, gold and platinum coverage. Bronze plans tend to offer "bare bones" coverage for a lower premium, while platinum plans typically provide the most generous coverage in exchange for a higher premium.
What is cost-sharing?
Cost-sharing is any cost paid above and beyond the monthly premium in order to access care. Cost-sharing includes deductibles, copays, and coinsurances.
A deductible is the amount of out-of-pocket spending required of a patient before the patient's plan will begin to make payments for the benefits and services covered by the plan. For instance, if your plan has a $1,000 deductible, you are expected to spend $1,000 out of your own pocket for covered benefits and services before your plan begins to make payments on your behalf. Deductibles have grown significantly in recent years, and consumers should make sure they understand the deductible for each plan they are considering. Note that some plans include more than one deductible.
Copays are flat dollar amounts that a patient pays in order to see a doctor, for example, or to purchase a prescription medication. Coinsurances are different than copays because they require the patient to pay a percentage of the total actual cost associated with the doctor visit or prescription drug. Due to the high cost of many services and medical products, coinsurances often mean significantly higher out-of-pocket costs.
The deductible and the level of coinsurance is an especially important consideration for blood cancer patients, particularly those who depend on costly oral medications. When shopping for coverage, patients ought to consider these two factors, as this will help a patient better understand the total costs they will be expected to pay in addition to a plan's premium.
What can I do if in the middle of the year I decide my coverage isn't adequate for my healthcare needs?
The open enrollment period is the only time during the year when you can switch coverage. If you decide during the year your coverage isn't adequate, you will not have an opportunity to switch to a different plan until the next open enrollment period. The only exception to that is if you experience certain life-changing events during the course of the year, such as divorce, pregnancy, the loss of employer-provided coverage, or a qualified hardship.
How can I find out if the particular medications I take to treat my disease are covered and what the cost of these medications will be?
You will need to review the documents provided for the insurance plans you are considering. Look for each plan’s formulary – the list of drugs covered by the plan – and search for the name of each medication you take. Cost-sharing for each medicine should be listed on the formulary as well.
How do I know if I qualify for financial assistance from the federal government?
By providing information during the enrollment process regarding your household income, the exchange website will automatically let you know if you qualify for financial assistance. This may include a tax credit to help pay your premiums, or eligibility for a silver plan that has reduced cost-sharing requirements.
If I receive co-pay assistance from LLS today may I continue to receive it if I purchase coverage on the exchange?
If you still need assistance with the premiums or cost-sharing associated with your exchange plan, and you still qualify under the conditions of the LLS Co-pay Assistance Program, yes, you may still receive this form of assistance from LLS.
For assistance contact an LLS Information Specialist.