TN What Do I Need to Know Now That I Have Health Care Coverage in Tennessee? The goal of the Affordable Care Act (ACA) is to get 100% of Americans covered by health insurance by 2016. This factsheet answers several frequently asked questions about using health insurance in your state. For more specific questions about your coverage, please contact your health insurance provider or doctor for further information. 1. If I enrolled for insurance in 2014, do I need to re-enroll? If you bought a health plan through the Marketplace in 2014, you’ll be automatically enrolled for 2015, as long as you continue payments, and your coverage will start January 1, 2015. Still, you should update the information on your application, and check out all plans available to you for 2015. Better plans and prices may be available to you this year, and it’s important that you get the right amount of savings, based on your updated information.
2. What’s considered preventive care and covered free of cost? You are encouraged to maintain your good health by visiting your provider, at least annually, for routine preventive health care, before you become ill. Most prevention services are fully covered by insurance, without any out-of-pocket expenses to you; these services may include tests, immunization
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shots and screenings for conditions like Type 2 diabetes. For more information on additional prevention services, visit healthcare.gov/ preventative-care-benefits.
3. How do I find a doctor? If your plan has a provider network, you should find a health care provider who serves patients in your insurance plan. Also, ask friends and family for recommendations, and check the internet to find a provider that can meet your needs in terms of office hours, location and language accommodations.
4. Will my insurance cover me if I am already sick before I obtain insurance? Health insurance companies can’t refuse to provide you with coverage, even if you are already sick. The ACA ensures that even preexisting health conditions will be covered by insurance. There are no annual or lifetime limits (caps) on the amount that insurance companies will pay out for your care during an illness.
5. What happens if I choose to drop my coverage or not obtain coverage? If you are not covered in 2015, you will be charged a penalty fee of 2% of your income, or $325 per person without health insurance coverage in your household, whichever is larger. However, in cases of financial hardship, and similar circumstances, there
are exemptions to paying this penalty fee. To learn more about these exemptions and how to apply for them, visit: healthcare.gov/feesexemptions/exemptions-from-the-fee.
Glossary Benefits – The health care items or services covered under a health insurance plan. Co-insurance – Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. Co-payment – A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. Typically, copayments are lower for visits to your primary care provider, and may be higher for specialist visits, and various medical tests. Dependent Coverage – Insurance coverage for family members of the policyholder, such as spouses, children, or partners. Insurance Premium – The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.
Insurance Deductible – The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve paid out $1,000 for covered health care services. Marketplace – This word refers to a Health Insurance Marketplace. They are resources where individuals, families, and small businesses can: learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. The Marketplace encourages competition among private health plans. It is accessible through websites, call centers, and in-person assistance. In Tennessee, it is run by the federal government. Network – The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services Pre-existing condition – A health problem you had before the date that new health coverage starts.
State Resources Tennessee residents can apply for health insurance at http://www.healthcare.gov. Navigator and certified application counselor organizations can answer your questions about health insurance and help you apply for health insurance. They are impartial third parties offering free service. You can find the nearest navigator or certified application counselor at http://www. getcoveredtenn.org, or you can make an appointment by calling 1-844-644-5443.
Note: This document has been prepared in good faith on the basis of information available at the date of publication. The SHEC does not guarantee or warrant the accuracy, reliability, completeness or currency of the information in this publication.
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