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Irena Hood
Irena Hood

Buying A Health Insurance Plan



The Affordable Care Act (ACA) provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. Under the ACA:




buying a health insurance plan



Visit HealthCare.gov to apply for benefits through the ACA Health Insurance Marketplace or you'll be directed to your state's health insurance marketplace website. Marketplaces, prices, subsidies, programs, and plans vary by state.


If you have questions about specific parts of your insurance plan, you must contact your insurance company to get answers. Only your insurance company can answer specific questions about doctors, medications, treatments, medical equipment, and what is and is not covered under your plan.


Businesses with 50 employees or fewer can offer Small Business Health Options Program (SHOP) plans to employees, starting any month of the year. Learn about small business tax credits to help companies with the equivalent of fewer than 25 full-time employees provide insurance coverage to their workers.


Most health insurance plans and Medicare severely limit or exclude long-term care. If you want coverage, you may need a separate long-term care insurance policy. These questions can help you evaluate long-term care insurance policies.


Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Learn about eligibility, how to apply and coverage.


Get more from your health plan coverage for less. Enjoy plan benefits like $0 preventive care, access to walk-in clinic care* with extended hours and weekends and virtual care through MinuteClinic.**


*For a complete list of participating walk-in clinics, log in to Aetna.com and use our provider search tool. Walk-in appointments are based on availability and not guaranteed. Online scheduling is recommended. Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states.


For TX/GA: Includes select walk-in clinic services. Not all walk-in clinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative walk-in clinic services at no cost-share.


**Applicable cost-share may vary based on services and providers. Please consult benefit documents for more details. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates.


If you have lost health insurance or no longer qualify for NJ FamilyCare, you may be able to get health coverage through GetCoveredNJ. Compare health plans, costs, and learn how much financial help you may qualify for now. Nine out of 10 residents enrolling qualify for financial help.


Choosing health insurance is one of the most important decisions you can make to help protect your and your family's health and well-being. It can be hard to find the right plan and understand the details of your coverage but the Pennsylvania Insurance Department is here to provide information and answer any questions you might have along the way.


No one plans to get sick or hurt, but most people will need medical care at some point. Health insurance covers essential health benefits, medical care for illness and accidents and protects you from unexpected, high medical costs. Not having insurance can result in large medical bills or avoiding necessary medical care.


Every year, the Pennsylvania Insurance Department reviews all proposed health insurance rates and changes to existing rates for plans in the individual and small group markets. We have a number of resources available to help consumers understand this process and obtain information about requested and approved changes to their rates.


Major medical plans usually cover hospital and medical expenses for an accident or illness. Some of them may also cover preventive care and office visits. These plans usually cover a percentage of your covered costs. Example: the plan pays 80% of your hospital stay and you pay the other 20%. With these plans, you are covered for any licensed health providers.


Whether you choose a major medical plan, an HMO or a PPP, your plan will probably have some "cost-sharing" features. This means that you share the cost of care by paying part of the charge for each service and the insurance company pays the rest. Pick a plan that works best with the type of health insurance you think you will use. Different cost sharing features are listed below:


A deductible is the amount you pay before the plan starts to pay for most covered services. You usually must pay your deductible first, and then your other cost sharing begins, such as copays and coinsurance.


There are many different ways that you can buy a health plan in Massachusetts. Many people get their health plan through their place of employment. For people that can't do this, there are several other ways to get a health plan.


In Massachusetts over 70% of all employers offer health insurance as a benefit to their employees. Most of these employers pay part of the premium and also offer a choice of several health plans. You can choose the health plan that is best for you from the choices offered.


If you are enrolled as a student in a Massachusetts college or university, you can buy a health plan through your school. This SHIP id designed for students and is only available while you are enrolled.


Massachusetts residents can buy health plans directly from an insurance company. And the company can't turn you down if you have a health condition. Sometimes the company will direct you to purchase their health plan through an intermediary. An intermediary is a company that takes care of the enrollment and premiums.


If you do not work for an employer that pays at least 33% of your health plan premium, you may be able to purchase a health plan from the Connector. These are plans offered by Massachusetts HMOs that the Connector has picked to have good value.


You may be eligible for subsidies to help you pay the premiums, depending on your income. Any Massachusetts resident can enroll in a health plan during the annual open enrollment period. Otherwise, you may be able to enroll at other times during the year if you have special circumstances (qualifying events). For example, recently moving to Massachusetts or recently losing your health insurance.


When choosing a health plan, it is important to consider the differences between your options. Some plans provide more generous coverage, while others could leave you responsible for high medical bills. Shopping for health insurance can be overwhelming, but remember, if the plan sounds too good to be true, it probably is.


Do not buy a discount plan as an alternative to health plan coverage. Discount plans charge a monthly fee in exchange for access to health care services at a reduced fee. These plans are not insurance and do not make any payments when you need health care services. Instead, they allow you to get a discount off of some of your medical charges. Discount plans may look like a cheap health plan, but they are not health insurance and they do not meet your Massachusetts "individual mandate" requirement for health coverage. You should check with your doctor or local pharmacist to ask whether you will receive any real savings before you give your money or your personal information to anyone offering health care discounts.


These plans allow groups of people with a religious affiliation to share in the costs of certain specified health care costs. HCSMs are not insurance and not supervised by state insurance departments. Members typically pay a monthly fee that allows them to submit qualifying medical expenses for sharing with other HCSM members. There are not specific consumer protections that apply to these plans. They may not guarantee any payments, and they do not necessarily pay expenses for the same kinds of services that health insurance covers.


Always take a close look at plan benefits and limitations before you sign up or pay any fees. That way you can see in advance if the plan is right for you and your family. Ask what benefits the plan does and does not cover, what benefits have limits; ask whether the plan covers your prescription drugs; ask where you can view a list of the health care providers in the plan's network.


Do not be fooled by bogus health plans selling on the internet or through unsolicited faxes or phone calls. You should always be careful when surfing the web. Review any website carefully and look for disclaimers such as "this is not insurance" or "not available in Massachusetts."


When you do find a health plan that looks like it meets your needs, check the Division of Insurance website or call to find out if the company is licensed to sell that type of insurance in Massachusetts before you commit to buying the product. Be careful not to give out personal information or make a payment in response to an unsolicited fax or without checking it out first.


Health insurance is also called a health benefit plan. Health benefit plans cover preventative services like wellness visits, shots, and screening tests. These services help you stay healthy and avoid future health problems.


If you have a qualifying event, you may get a special enrollment period (SEP) to buy an individual health plan. This means you can enroll in or change your health insurance plan outside the standard open enrollment period. For some types of special enrollment events, special enrollment periods last 60 days from the date of the qualifying event (see below for examples). However, for the most common occurring special enrollment events, such as a loss of coverage, you may also enroll 60 days in advance of the special enrollment event. If you don't qualify for a SEP, you'll need to wait until the next open enrollment period. 041b061a72


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