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Health Insurance

Health Insurance is a contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.

Get quick answers about Obamacare laws and the Health Insurance Marketplace
Get answers about the Health Insurance Marketplace & Obamacare

Coverage


Individual health insurance coverage can be purchased in two different ways: on the new Health Insurance Marketplace, or through insurance companies and/or insurance agents off the Marketplace.


Pre-existing Conditions


Health insurance companies may not deny you coverage on or off the marketplace just because you have a pre-existing condition. If you have a pre-existing condition, it is important to get enrolled in coverage during the open enrollment period, which begins November 1, 2016 for coverage January 1, 2017. If you do not get enrolled before open enrollment ends in January 31, 2017, you may not be able to get coverage until the next open enrollment period for 2018.


Grandfathered Health Plans


Any individual health policy purchased on or before March 23, 2010, may be considered "grandfathered." Grandfathered plans are health insurance plans that are exempt from certain changes required under the Affordable Care Act. Plans lose this "grandfathered" status if the policy makes significant changes that reduce benefits or increase cost to consumers. A health plan must disclose to its policyholders if it considers itself to be "grandfathered."


Responsibility & Cancellations


Beginning January 1, 2014, almost all individuals must have health insurance or pay a tax penalty, with some exceptions. For the year 2014, the maximum penalty for a family is $285. This will increase to a $2,085 maximum family penalty in 2016 and beyond.

Insurance companies cannot cancel or rescind your health insurance policy because you made an honest mistake on your insurance application. The insurance company can still cancel your coverage if you submit false or incomplete information on purpose, or if you don't pay your premiums.


Paying for Insurance


Plans available on and off the marketplace typically have a network of providers available and set a maximum amount you will pay out of your pocket, in addition to your premium. These costs include a deductible, copayments and coinsurance. You have these responsibilities:

  • Pay your premiums – if you stop paying, your coverage will end.
  • Meet your deductible – you must pay the deductible before you insurance company begins to pay for some services other than preventive care.
  • Pay your coinsurance and copayments – you will pay these until you meet the out-of-pocket limit.
  • Meet your out-of-pocket limit - This is the maximum amount you pay for in-network service in one year.

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