Health Insurance FAQ

DescriptioHealth insurance – also referred to as medical insurance or healthcare insurance – refers to insurance that covers a portion of the cost of a policyholder’s medical costs. How much the insurance covers – and how much the policyholder pays via copays, deductibles, and coinsurance – depends on the details of the policy itself, with specific rules and regulations that apply to some plans.

If you don’t have health insurance and you end up needing medical care, you can be left with insurmountable medical bills or even face situations in which medical providers refuse to treat you. Only screening and stabilization in a hospital emergency department are guaranteed if you’re uninsured. Other than that, it’s up to the provider to decide whether to treat you if your ability to pay for the care is in question. Even if your out-of-pocket costs seem high under the health plans available to you, having a health insurance card might make the difference between being able to obtain care or not.

It’s also important to understand that you cannot just purchase health insurance when a medical need arises. Regardless of whether you’re buying your own coverage or enrolling in a plan offered by an employer, there’s an annual open enrollment period that applies, and enrollment outside of that window is limited to special enrollment periods triggered by qualifying events.n text goes here

There are different types of Marketplace health insurance plans that are designed to meet various needs. Some types of plans limit your provider choices or encourage you to seek care from their plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Other health insurance plans pay a greater share of costs for providers outside of your plan’s network.

Types of Marketplace plans

Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, and Platinum.

A few examples of plan types you’ll find in the Marketplace are:

Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

Obamacare is not an insurance policy or network. It’s just another name for the Affordable Care Act (ACA), which is a law that was implemented in 2010. All-new individual and small-group health insurance policies had to be fully compliant with Obamacare starting January 1, 2014. This is the case regardless of whether they’re sold through the Marketplace or purchased directly from a carrier if you do not qualify for a tax credit.

ACA (Obamacare) Explained:

ALL PLANS MUST INCLUDE THE 10 ESSENTIAL HEALTH BENEFITS

Hospitalization, Emergency Services, Prescriptions, Mental Health & Addiction Services, Pediatric Services, Preventative Health Care, Pregnancy, Maternity & Newborn Care, Ambulatory Services, Laboratory Services, Rehabilitative Services

· People with preexisting conditions cannot be denied. Coverage cannot be dropped or premiums raised due to illness.

· No cost preventative services. Aimed to keep people healthy & identify conditions early on

· No lifetime or annual coverage limits

· Children can stay on parent’s insurance until age 26

· Tax credits based on household income (up to 400% of poverty level) reducing premiums & out of pocket expenses

· If your household income is too high, you can still enroll in a plan but you will not receive a tax credit

· Established the ACA Marketplace, providing health plan shopping, determines tax credit, and enrollment

· Open enrollment periods established or throughout the year if you have a special life event occur

When the Affordable Care Act was written, lawmakers knew that it would be essential to get healthy people enrolled in coverage, since insurance only works if there are enough low-cost enrollees to balance out the sicker, higher-cost enrollees. So the law included an individual mandate, otherwise known as the shared responsibility provision.

But that tax penalty was eliminated after the end of 2018, under the terms of the Tax Cuts and Jobs Act of 2017. Technically, the individual mandate itself is still in effect, but there’s no longer a penalty to enforce it.

If you enroll in a high-deductible health plan (HDHP), you’ll be eligible to fund an HSA. You can use HSA funds to pay for deductibles, copayments, coinsurance, and other qualified medical expenses. Withdrawals to pay eligible medical expenses are tax-free.HDHPs are available through the Affordable Care Act’s marketplace.

An HDHP plan has a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). HDHPs cannot pay for any non-preventive services before the aforementioned minimum deductibles are met.

Under the Families, First Coronavirus Response Act, Medicare, Medicaid, and private health insurance plans are required to fully cover the cost of COVID-19 testing.

However, plans that aren’t considered minimum essential coverage (ACA plans) aren’t required to cover COVID-19 testing.

No. Treatment for infertility is not one of the ten essential benefits, and coverage for it is not mandated by the ACA or any other federal laws. States can have regulations that go beyond the minimum requirements laid out by the federal government. However, Michigan does not cover infertility testing or treatment.