HEALTH CARE LAW WORDS TO KNOW
When it comes to the health care law, there are a few terms you will come across that might be confusing. Here are some definitions to help you understand what they are talking about:
Some state CHIP programs also provide health coverage or health services for low-income pregnant women. It's important to note that CHIP (and Medicaid) enrollment occurs year-round and you can enroll in coverage any time.
Essential Health Benefits:
The basic health care services all plans must cover, like: preventive care (including annual well-woman exams and birth control), prescription drugs, hospital stays, emergency services, maternity and newborn care, and more.
Health Insurance Marketplace:
A website where you can see all of the new insurance plans available in your state. You can use the website to search for a plan, compare plan coverage and costs side by side, find out if you qualify for financial help and sign up for a plan right there.
Your state might call the Marketplace an “Exchange” or something else. For example, in California, the Marketplace is called Covered California.
Health Plan Categories:
Health plans available on the Marketplace are organized into categories: Bronze, Silver, Gold and Platinum. All plans must cover essential health care services—including hospitalizations, maternity and newborn care, prescription drugs and preventive care.
The different categories reflect different price structures. Platinum plans will have higher monthly premiums, but lower out-of-pocket costs when you get care. Bronze plans will have lower monthly premiums, but higher out-of-pocket costs when you get care. Silver and Gold plans will fall somewhere in the middle.
Public-funded health insurance coverage that is available for free or very low-cost for low-income individuals and families. Medicaid coverage may be called by a different name; for example, in California, Medicaid is called Medi-Cal. Just like with private insurance, Medicaid provides coverage of important preventive women's health services, like birth control and well-woman exams, for free without cost-sharing. For more information on Medicaid, click here.
People who are trained Marketplace experts, available to help you on the phone, online or in person. There will also be people called Certified Application Counselors (CACs) and In-Person Assisters (IPAs). All of these people (Navigators, CACs, and IPAs) are not salespeople, and they are there only to help you and answer questions, not sell you a plan. Use our tool to find in-person help in your area. Use our tool to find in-person help in your area.
This is the time when you can sign up for a new insurance plan on the Marketplace. You can only enroll in a Marketplace plan during this time period, unless you qualify for a special enrollment period. Medicaid and CHIP enrollment is open year-round, meaning you can apply for and enroll in Medicaid/CHIP coverage at any time. The open enrollment period for 2016 has closed. The 2017 open enrollment period is November 1, 2016 through January 31, 2017.
Special enrollment period:
After the open enrollment period ends, individuals who do not qualify for Medicaid and have experienced certain qualifying life events may qualify for a special enrollment period, which allows them to enroll in Marketplace coverage outside the annual open enrollment period. For example, individuals who have a change in family size because they got married or had a child after January 31, 2016 may qualify for a special enrollment period to sign up for a new Marketplace plan. Special enrollment periods typically last 60 days from the start of the qualifying life event.
Click another question below, or enter your zip code in the form at right to find out which plans include Planned Parenthood.