Tag: marketplace

I’m a migrant seasonal worker. Can I buy health insurance in the Marketplace where I live now? If I move to another state during the year, can I keep the plan I bought here or will I have to buy different coverage?

Eligibility to buy coverage in the Marketplace is based on where you establish your permanent residence. Some health insurers will offer larger networks than other plans and may offer regional or national provider networks. Once Open Enrollment begins, check the plans available in your Marketplace to see if there is a plan with provider coverage in the areas you work.  If your move during the year is a permanent move, not just a temporary one, you may qualify for a special enrollment period following the permanent move.

Can family members in families with mixed immigration status, where some family members are citizens or lawfully present and others are undocumented, enroll in Medicaid or CHIP or receive help buying coverage through the Marketplaces?

Citizen and lawfully present family members can get health insurance coverage through Medicaid, CHIP, and Marketplaces even if other family members are not lawfully present. Family members who are not lawfully present, including undocumented immigrants, may apply for health insurance for citizen and lawfully present family members. For example, an undocumented immigrant parent may apply for health insurance for a citizen child.

When a family with mixed immigration status applies for health insurance, it only has to give citizenship and immigration status for those family members applying for coverage. Non-applicants, such as a parent applying for a child, do not have to provide citizenship or immigration status. Non-applicants will be asked to provide a Social Security Number, but do not have to provide one unless the family is applying for help with costs for Marketplace coverage and the individual is the tax-filer for the household, and the individual has a SSN.  Information provided by applicants will not be used for immigration enforcement purposes.

Can immigrants get help paying premiums and/or cost-sharing for health insurance in the Marketplaces?

Lawfully present immigrants can get tax credits to help pay premiums and cost-sharing for health insurance through the Marketplaces. Like citizens, they can get tax credits to help pay premiums if they make between 100% and 400% of the federal poverty level. They can also qualify for cost sharing reductions if they make between 100% and 250% of the federal poverty level.  To get this help, they cannot be offered affordable health insurance through their job or be eligible for Medicaid.

Lawfully-present immigrants who make less than 100% of the federal poverty level  also can get help paying premiums and cost sharing if they cannot enroll in Medicaid due to immigration status. Many lawfully-present immigrants cannot enroll in Medicaid until they have been in the United States for five or more years.

Undocumented immigrants cannot receive help paying for premiums or cost sharing for Marketplace coverage and may not buy health insurance through the Marketplaces even at full cost.

I am currently uninsured and plan to purchase coverage through the health insurance Marketplace. Do the insurance plans in the Marketplace cover abortions?

It depends on where you live and the specific plan you choose. Some states allow plans in the Marketplace to cover all abortions and some states prohibit or limit plans’ coverage of abortion to certain cases. In half the states, Marketplace plans are prohibited from offering coverage that includes abortions, or are restricted to covering abortions in very limited circumstances. You should check the plan details to find out whether your plan covers abortion services.

How do I project my household size/income for next year if I’m pregnant now? I’m married and this pregnancy will be our first child. We want to find subsidized coverage in the Marketplace.

During Open Enrollment, you and your spouse will apply as a household of two. When the baby is born, you can update your family information with the Marketplace to reflect that you have become a household of three. At that point, you may qualify for a larger premium tax credit. (For example, if you and your spouse together expect to earn a 2019 income that is twice the federal poverty level for a household of two ($32,920), you would be required to contribute about 6.54% of your household income toward the premium for the benchmark plan in the Marketplace. Once the baby is born and you are a household of three, that income would constitute just 158% of the federal poverty level for a family of three and you would only be required to contribute about 4.15% of your income. When you report your new family status to the Marketplace you will also have a 60-day special enrollment opportunity to add the baby to your plan and increase your advanced premium tax credit amount.  You will also have the option of enrolling your baby in a different plan.  However, you and your spouse generally will not be able to change health plans as a result of the “newborn” special enrollment period.

I just found out that I’m pregnant and my baby is due in March. Can I enroll in a plan though the health insurance Marketplace?

Yes.  However, you may only enroll during Open Enrollment period (November 1, 2016 – January 31, 2017).  Once enrolled, your plan will be required to cover maternity services.  You may also qualify for a premium subsidy, depending on your family income and your eligibility for employer coverage.  Once born, you can add the baby to the plan.  You will also be allowed to change plans at that time.  Birth of a child is a qualifying event that allows you to enroll in or change your coverage, no matter when during the year the baby is born.  Your special enrollment period will last for 60 days from the date of birth.  Adding the baby will change the plan premium and also your subsidy, assuming you qualify for premium tax credits. Depending on your income and the state you reside in, you might also qualify for Medicaid and there is not a limited open enrollment period for Medicaid.

I’ve been uninsured and just enrolled in a health plan through my Marketplace. I’ve been getting my birth control at a Family Planning Clinic. Will I still be able go there to get my birth control for free?

It depends. Your Family Planning Clinic may be a covered provider in your new health plan network. If so, you can continue to go there for your birth control without cost-sharing. If your Family Planning Clinic is not in the network, you may still qualify for free or reduced cost services from the clinic. Check with your clinic for more information.

I am purchasing health insurance in my state’s health insurance Marketplace. Is my plan required to cover contraceptives without cost?

Yes, your plan must cover the full range of FDA-approved contraceptive methods, but can impose some restrictions on the contraceptives offered at no cost to you. For example, the plan may require that you choose a provider within the network, and use generic rather than brand name contraceptives, unless the brand name is medically necessary. If the generic drug or device does not work for you, you can ask your doctor to request a waiver from the insurance plan to receive the brand name drug or device without cost sharing.

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