Affordable Care Act Marketplace Insurance | Billing | Loyola Medicine

Affordable Care Act Marketplace Insurance

Health Insurance Marketplace

Have you experienced recent life changes? Need health insurance and not sure where to begin?

Help is available. Call 800-318-2596 to speak with someone who can help you navigate your options.

Health Insurance Provides Peace of Mind

Having health insurance reduces or eliminates your risk of facing major expense if you or a family member suffers from an illness or injury.

Health insurance can be affordable. For some, government subsidies offset the cost of insurance. Others may be eligible for Medicaid when previously they were not. Avoiding penalties for not having insurance should be a factor too. Most importantly, health insurance provides peace of mind.

For millions of uninsured or underinsured people, the Health Insurance Marketplace allows you to compare plans to find one that fits your budget and coverage needs. Based on income and family size, you may even qualify to receive financial assistance when purchasing these plans.

What Will the Health Insurance Marketplace Plans Cover?

All plans include coverage for doctor visits, hospital stays, wellness care, prescriptions, emergency services, maternity and newborn care, pediatric services, laboratory services, rehabilitative services and devices, and mental health and substance use disorder services. Plans can also offer benefits like vision, dental, or medical management programs for specific diseases or conditions.

Health insurance Marketplace plans fall into four categories – Bronze, Silver, Gold, Platinum. Each plan has its own monthly and out-of-pocket costs:

  • Bronze covers 60% of the total average costs of care
  • Silver covers 70% of the total cost of care
  • Gold covers 80% of the total cost of care
  • Platinum covers 90% of the total cost of care

Open Enrollment

If you do not have health insurance, you must sign up for 2021 coverage during open enrollment, November 1, 2020 – December 15, 2020. You can shop for plans by phone, through a broker, or at the online Marketplace, where you can compare benefits and costs easily.

If you currently uninsured, you should sign up for health coverage. With health insurance, you will be covered for things like doctors' visits and prescription medicines, which are not covered now – and may not be covered when your coverage ends.

If you are interested in more information, call 800-318-2596 to speak with someone who can help direct you.

You can also visit Healthcare.gov for additional information.

If You’re Renewing Your Marketplace Health Insurance Plan

The Open Enrollment Period is the time for you to shop for new coverage or decide to stay in the same, or a similar, plan. Your health insurance company will send you a letter by November 1, 2020, to let you know if your plan is still being offered and how the plan is changing.

Beginning November 1, 2020, you can:

  • Update your application information.
  • See if you qualify for new or different help paying for your premiums and out-of-pocket costs.
  • Compare available plans.
  • Enroll in a plan that meets your needs.

In most cases, if you do not act, your health insurance company will automatically enroll you in the plan you currently have or the most similar one to it if your plan is no longer available. Call 800-318-2596 to make sure your current plan is still right for you.

Remember, you must enroll in a plan by December 15, 2020, for coverage in 2021, unless you qualify for a Special Enrollment Period. A Special Enrollment Period is granted if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. See if you qualify for a special enrollment period.

*You can also visit www.HealthCare.gov/keep-or-change-plan. TTY users should call 1-855-889-4325.

You May Qualify for Financial Assistance Paying for Insurance

A surprisingly large number of people qualify for financial help when buying health insurance through the Marketplace. By using one of the calculators available, you can estimate how much assistance you could obtain—before you even visit the Marketplace site (www.HealthCare.gov). However, only the Marketplace will let you know the exact assistance you can expect.

Financial Assistance Calculator

This tool offered by Healthcare.gov provides a quick view of income levels that qualify for savings. Certain individuals may qualify at different levels. You’ll learn your exact savings and plan prices when you fill out a Marketplace application.

https://www.healthcare.gov/lower-costs/qualifying-for-lower-costs/

Another calculator option, from the Kaiser Family Foundation, is found below:

This tool developed by the Kaiser Family Foundation estimates health insurance premiums and subsidies for people purchasing insurance in the Marketplace.

Enter different incomes, ages, and family sizes to estimate your eligibility for subsidies and how much you could spend on health insurance:

2021 Financial Assistance Income Chart

Look for your income and household size on this chart to see whether you qualify for financial assistance when purchasing health insurance.

Household Size

100%

133%

150%

200%

300%

400%

1

$12,760

$16,971

$19,140

$25,520

$38,280

$51,040

2

$17,240

$22,929

$25,860

$34,480

$51,720

$68,960

3

$21,720

$28,888

$32,580

$43,440

$65,160

$86,880

4

$26,200

$34,846

$39,300

$52,400

$78,600

$104,800

5

$36,080

$40,804

$46,020

$61,360

$92,040

$122,720

 

Be Sure to Pick a Plan that Includes Loyola University Medical Center in Its Network

When you compare plans, you'll be able to see which hospitals are included in each one.

Be sure to choose a plan that includes Loyola University Medical Center in its network so you'll always have the latest treatment options, leading-edge technology, and the region's top-rated and most experienced physicians offering care centered around you and your needs.

To learn more and find a plan right for you, call 708 216-5014, option 5 to speak to someone who can help direct you.

Preventive Care Services

All marketplace plans must cover the following list of preventive services without charging you additional fees (copayment or coinsurance), even if you haven't paid your yearly deductible. However, you must receive these services from a healthcare provider in your network.  Screenings are also available based on certain criteria and conditions.

Preventive Screenings For All Adults

  1. Abdominal aortic aneurysm one-time screening
  2. Alcohol misuse screening and counseling
  3. Aspirin use
  4. Blood pressure screening
  5. Cholesterol screening
  6. Colorectal cancer screening
  7. Depression screening
  8. Diabetes (Type 2) screening
  9. Diet counseling
  10. HIV screening
  11. Vaccines and immunizations
  12. Obesity screening and counseling
  13. Sexually transmitted infection (STI) prevention counseling
  14. Syphilis screening
  15. Tobacco use screening

Preventive Screenings For Women

  1. Anemia screening
  2. Breast cancer genetic test counseling (BRCA)
  3. Breast cancer mammography screenings
  4. Breast cancer chemoprevention counseling
  5. Breastfeeding comprehensive support and counseling
  6. Cervical cancer screening
  7. Chlamydia infection screening
  8. Contraception
  9. Domestic and interpersonal violence screening and counseling
  10. Folic acid supplements
  11. Gestational diabetes screening
  12. Gonorrhea screening
  13. Hepatitis B screening
  14. HIV screening and counseling
  15. Human papillomavirus (HPV) test
  16. Osteoporosis screening
  17. Rh incompatibility screening
  18. Sexually transmitted infection (STI) counseling
  19. Syphilis screening
  20. Tobacco use screening and interventions
  21. Urinary tract or other infection screening
  22. Well-woman visits

Preventive Screenings For Children

  1. Alcohol and drug use assessments for adolescents
  2. Autism screening
  3. Behavioral assessments
  4. Blood pressure screening
  5. Cervical dysplasia screening
  6. Depression screening
  7. Developmental screening
  8. Dyslipidemia screening
  9. Fluoride chemoprevention supplements
  10. Gonorrhea-preventive medication
  11. Hearing screening
  12. Height, weight and body mass index measurements
  13. Hematocrit or hemoglobin screening
  14. Hemoglobinopathies or sickle cell screening
  15. HIV screening
  16. Hypothyroidism screening
  17. Immunization vaccines
  18. Iron supplements
  19. Lead screening
  20. Medical history
  21. Obesity screening and counseling
  22. Oral health risk assessment
  23. Phenylketonuria (PKU) screening
  24. Sexually transmitted infection (STI) prevention counseling and screening
  25. Tuberculin testing
  26. Vision screening