Health Insurance Enrollment – FAQ

By Madelyn Ryan

If you don’t have health insurance, your opportunity to enroll in a subsidized health insurance plan is here.

On November 1st, Americans without health insurance will have an opportunity to enroll in the health insurance marketplace. And for those over the age of 65, open enrollment is available now through December 7th, 2015. There is still a lot of confusion that surrounds the differences between subsidized health insurance programs.

Medicaid Advisory Group advocates and educates families and patients that are trying to navigate the complicated health care maze. Because the open enrollment is now here, their social workers put together a list of their most commonly heard questions.

What’s the difference between the Medicare, Medicaid and the Health Insurance Marketplace?

Medicare is for people 65 and older. You can determine your eligibility and calculate your premium by clicking here.

Health Insurance Marketplace is primarily for Americans who don’t have health insurance through a job or other subsidized health insurance program. Coverage and eligibility varies by state, but you can compare plans and prices by clicking here.

Medicaid eligibility varies by state, but on average, anyone who makes $16, 243 or less annually qualifies for coverage. You can go here, to find out if you qualify for coverage in your state.

What are the deadlines for enrollment in coverage for 2016?

Medicare – Open enrollment is from October 15 to December 7, 2015

Health Insurance Marketplace – Open Enrollment is from November 1, 2015 to January 31, 2016

Medicaid – There is no enrollment period, eligible individuals can enroll in Medicaid anytime throughout the year.

What healthcare benefits will I receive?

Medicare – There are four parts to Medicare: “Medicare Part A,” “Medicare Part B,” “Medicare Part C,” and “Medicare Part D.” Part A is hospital insurance. Part B is medical insurance. Part C is also known as “Medicare Advantage Plans” and allows private insurance companies to provide its clients with the same benefits as Medicare. Part D is prescription drug coverage. Medicare does not have to cover essential healthcare benefits, so it is possible to get more complete coverage by enrolling in Medicare and Medicaid at the same time.

Health Insurance Marketplace – These plans cover “essential health benefits” as well as pre-existing conditions and preventative care

Medicaid – All Medicaid plans are required to cover essential health benefits. Some required benefits include emergency services, hospitalization, mental health and substance use disorder services, prescription drugs, chronic disease management and oral and vision care. A more extensive list of essential health benefits can be found here.

What happens if I don’t enroll in health insurance?

The US government requires everyone who can afford a health insurance plan, including Medicaid, to enroll in coverage. If you choose not to enroll in a health insurance plan, you have to pay an uninsured fee to the government. And, in 2016 the fee for not enrolling in health insurance coverage is higher than it was in 2015.

If you have other questions on enrolling in a subsidized health insurance program, you can call the Medicaid Experts at 646-745-9122.

Here’s a video that tells you more on how Medicaid Advisory Group is helping people navigate the health care system.