Health Insurance Marketplace Information for Nurses
November 2014
A million Arizonans, your patients, the people who have voted nurses the most trusted profession in the U.S. are counting on you to guide them through the new insurance system mandated by the Affordable Care Act (ACA). Consolidated here is information for you to use for yourself and your patients. This insurance program is currently called the “Health Insurance Marketplace”.
Contents:
- Quick Start
- Need to Know
- Basic Information
- Resources for Nurses
- Resources for Patients: Handouts
Quick Start
Click here for a one page "Call to Action" and nurse's guide to the Health Insurance Marketplace
Need to Know
People on MEDICARE do not need to do anything. The Health Insurance Marketplace is not connected to MEDICARE even though is it administered by the same governmental agency, CMS. Confusion has occurred due to the simultaneous sign up windows for the Health Insurance Marketplace open enrollment period and the MEDICARE open enrollment period, which is October 7-December 15.
People who already have health insurance do not need to do anything. This issue is a moving target at the moment. Criteria and coverage's are changing frequently. Advise patients to watch their mail for letters from their health insurance company, to READ those letters, and to call the company at once if there is information that they do not understand.
People Already On MEDICAID Do Not Need To Do Anything. The Federal low-income insurance program is known as MEDICAID. In Arizona, it is called AHCCCS (Arizona Health Care Cost Containment System). New laws have increased the categories of people who are eligible for AHCCCS. This Arizona website is used to sign up for AHCCCS coverage and helps anyone screen for available individual insurance options.
People Without Health Insurance Are Required To Purchase Health Insurance Or Pay A Penalty. At the beginning of January, 2014, the government website was reportedly working smoothly for persons opening an account and submitting applications for health insurance coverage through the Health Insurance Marketplace. The site evaluates a person’s eligibility and determines whether they qualify for Medicaid or subsidies or regular insurance. There are four ways to apply:
a) Apply online
b) Call the Marketplace Call Center 1-800-318-2596, where a trained representative can help you enroll. TTY users should call 1-855-889-4325.
c) Visit https://localhelp.healthcare.gov for a list of locations in your area where you can get in-person help with your application for coverage
d) Apply with a paper application
Basic Information
Dates
You can generally buy health insurance only during the annual open enrollment period. For information on exceptions and possible changes in these dates go to the main Health Insurance Marketplace site
- March 31, 2014: 2014 open enrollment ends
- November 15, 2014: 2015 open enrollment begins
- January 15, 2015: 2015 open enrollment ends
Subsidies
If a person’s annual earnings are 400% of the federal poverty level or less ($45.960 for an individual or $94,200 for a family of four) they may be eligible for a subsidy.
Navigators
There are four organizations in AZ serving as funded entities coordinating the Health Insurance Marketplace sign-ups. The organizations are called Navigators. They are: Arizona Association of Community Health Centers; Arizona Board of Regents, University of Arizona; Greater Phoenix Urban League, Inc. and Campesinos Sin Fronteras, Inc.
Assistors
Certified Application Counselor (CAC) organizations can train their staff to offer Health Insurance Marketplace application help to individuals. Person’s who help the public are called “Application Assistors”. See this site for more information. There are over 100 CAC in the greater Phoenix area. Find a CAC for your area.
Essential Health Benefits
Most health plans that will be offered by the Health Insurance Marketplace, with some exceptions, must cover the following ten “essential health benefits” or ESBs in order to be certified: Ambulatory patient services, Emergency services, Hospitalization, Maternity and newborn care, Mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care.
Premiums
According to plans submitted in late 2013 to the AZ Department of Insurance by insurance companies operating in AZ , average monthly rates will range from $225 to $334. The documents suggest Arizona consumers will be able to choose from a variety of plans and rates during the six-month enrollment period, with monthly premiums that will range from less than $100 to more than $1,700 per month. These rates are before sliding scale subsidies are factored in. The Kaiser Foundation calculator can estimate premium assistance .
Coverage
If consumers have any questions regarding their coverage from the Health Insurance Marketplace they should call the insurer of their choice or the Marketplace call center at 1-800-318-2596 to confirm enrollment or arrange payment of premiums. They can log in to their account to find out their insurer’s customer service line or browse through a directory on HealthCare.gov.
Resources for Nurses
Resources For Patients – Handouts
Links to each fact sheet are included below, or Click here and look under "Fact Sheets".
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