The Health Insurance MarketplaceA marketplace to compare and enroll in health insurance plans established by the Affordable Care Act (Obamacare). (Obamacare) provides many kinds of health plans. The cost of Marketplace plans will vary based on your income and the type of plan.
Low premiumThe amount you pay for your health insurance every month. In addition to your premium, you may have to pay other costs for your health care, including a deductible, copayments, and coinsurance. plans, tax credits, and other kinds of financial assistance are available to many people, but make sure to ask about them when you apply because not all insurance brokers or agents will check to see if you are eligible.
Who is Eligible?
, such as through MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). or your employer, you probably will not qualify for any financial assistance on the Marketplace. To find out what kinds of savings you are eligible for, you will need to apply for a Marketplace plan. See “Applying for a Marketplace plan” below.
Types of Marketplace Plans
Marketplace plans are divided into Bronze, Silver, Gold, and Platinum plans. All plans will cover preventative care, such as check-ups and cancer screenings, at no cost to you. The differences between the plans have to do with how costs are distributed (to you and to your health insuranceA type of insurance that pays for some or all of your medical expenses.
provider) and do not indicate the quality of the care you will receive.
When choosing a Marketplace plans, consider these different kinds of costs:
- PremiumThe amount you pay for your health insurance every month. In addition to your premium, you may have to pay other costs for your health care, including a deductible, copayments, and coinsurance., or the cost of the plan per month,
- DeductibleThe amount you must pay for health care or prescriptions before your health insurance begins to cover the costs. When you have paid this amount in a particular year, this is called “meeting your deductible.”, or how much you have to pay out-of-pocketCosts for health care or prescription drugs that you must pay on your own because they are not covered by your health insurance plan. for care you get before your health insurance provider starts to pay for it, and
- CoinsuranceThe percentage of the total cost of a healthcare service that you must pay after you have met your deductible., or the percentage of the cost of your care that you pay after you meet the deductible.
What Marketplace Plans Cover
All Marketplace plans will cover the following services, although you may have to pay a copaymentAn amount you may be required to pay for a medical service or supply, like a doctor’s visit or prescription drug. A copayment is usually a set amount, like $10 or $20. Also called a copay., which is a flat fee each time you get a service, or coinsuranceThe percentage of the total cost of a healthcare service that you must pay after you have met your deductible., which is a percentage of the cost of your care.
- Physical health services, such as check-ups, preventative care, diagnostic tests, and treatment for illnesses and injuries. You do not have to pay a copayment or coinsurance for preventative care.
- Behavioral health services, such as mental health and substance abuse services, including counseling and psychotherapy.
- Emergency care.
- Prescription medications, as long as they are on your health plan’s “formulary” or the list of medications your health will plan pay for.
- Rehabilitation services such as physical, occupational, and speech therapy.
- Some medical equipment.
- Some transportation, such as ambulance services.
Some Marketplace plans will also cover:
- Dental services
- Some of the cost of glasses, hearing aids, and other durable medical equipment, such as oxygen equipment, wheelchairs, or blood test strips, as long as they are “medically necessary,” meaning that your doctor has prescribed them to treat an illness or injury.
- Transportation services or reimbursement for transportation to non-emergency, medically necessaryThis refers to care or equipment that your doctor has prescribed to treat an illness or condition. services.
- Some traditional healing or alternative therapies, such as acupuncture or homeopathy.
To find out exactly what your Marketplace plan will cover, call the number on the back of your health insuranceA type of insurance that pays for some or all of your medical expenses.
card, visit your health insurance provider’s website, or review your Member HandbookThe handbook you receive when you sign up for a health insurance plan. It includes information on what providers are in your network, what benefits are covered, and how much they will cost. .
Applying for a Marketplace Plan
American Indians can apply for a Marketplace plan at any time during the year, not only during the “Open EnrollmentThe yearly period when people can enroll in a health insurance plan.” period. If you would like to apply yourself, you can apply online by going to Healthcare.gov.
Applying for or renewing a health plan can be complicated and confusing, so consider getting in-person assistance. You can get help applying for a plan from the Benefits Coordinator at your local Indian Health Service (IHS) or Tribal clinic, or a Patient Navigator or insurance broker. In New Mexico, BeWellNM has counselors specifically for American Indians; call them (855) 241-8137 or visit their office at 6403 Menaul Blvd. NE, Albuquerque, NM 87110.
When you apply for a Marketplace plan, you may need to provide the following documents or information:
- Proof of age (for example: birth certificate, driver’s license, passport)
- Proof of citizenship (for example: birth certificate, passport, Tribal enrollment card, Certificate of Degree of Indian Blood)
- Proof of all your sources of income (for example: paystubs, Social SecurityA federal program that provides retirement, disability, and survivor benefits. Most Social Security benefits are based on taxes that you paid on your wages while working., Supplemental Security IncomeA monthly benefit paid by Social Security to people with limited income who are disabled, blind, or age 65 and older. These are not the same as Social Security retirement or disability benefits., Veterans benefits, any other income)
- Proof of assets (for example: bank statements)
- Proof of disabilityAny condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them.
- Proof of residence (for example: recent mail addressed to you, rent receipts, a copy of your mortgage)
- Proof of any other health insuranceA type of insurance that pays for some or all of your medical expenses.
(any other current health insurance cards)
Using your Marketplace Plan and Staying Covered
Whenever you go to a healthcare provider, including the IHS, bring your insurance card with you and make sure the provider’s office knows what health plan you have. If a healthcare provider does not accept your health insuranceA type of insurance that pays for some or all of your medical expenses.
, ask them to refer you to one who does.
Enrollment in Marketplace health plans takes place every year. Once you are enrolled, you may be automatically enrolled in the same or a similar plan the next year without having to do anything, but it’s a good idea to re-visit your enrollment every year. American Indians can make changes to their Marketplace plans at any time, but during the Open EnrollmentThe yearly period when people can enroll in a health insurance plan. period (usually October-November), the plans that are offered, including costs, change. Make sure to read all the information you receive from your health insurance provider in case there are any important changes to your health plan.