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Answered: 10 Health Insurance Marketplace FAQs

Westshore Primary Care in Westlake, Ohio answers their top 10 patient questions about the Health Insurance Marketplace. Read more to find out how to keep your coverage if you choose a new plan. Image of question mark made with puzzle pieces by Horia Varlan is licensed under CC by 2.0.

With all the changes in the health insurance market, as well as increased opportunities to secure insurance coverage on your own, it is often difficult to know where to go for information or assistance.

If you are looking for (or updating) your insurance coverage, it’s important to know that each insurance company offers different plans with similar names, but they are not all accepted by your primary care physician.

Many people find it confusing looking at these plans because they may sound similar in name, but actually provide very different benefits.

In order to help you get a better understanding of the process and the Marketplace, we pulled together a list of your top questions.

10 Frequently Asked Questions About the Health Insurance Marketplace

1. What is the Health Insurance Marketplace?

The Marketplace (formerly referred to as the Exchange) was established as part of the Affordable Care Act (ACA) and provides a new way for individuals to shop for health insurance.

It was developed to provide consumers with the information necessary to make an informed decision and compare the available plans based on price, benefits and other features that are important to consumers.

Plans are presented in four categories – bronze, silver, gold and platinum. Additionally, the Marketplace can be used to obtain information about subsidies designed to assist consumers in paying for health insurance. Eligibility for a subsidy is based on income and family size. 

2. Can I still apply for an individual health plan offered through the Marketplace?

The open enrollment period ended on March 31, 2014 and will begin again in November 2014. However, you may qualify for the special enrollment period.

Special Enrollment Period

You may be able to enroll between April and November 2014 if you have a “qualifying life event.”

3. What situations are included in a “qualifying life event”?

Qualifying life events include:

  • Losing Medicaid eligibility
  • Moving to a new state
  • Certain changes in income 
  • Changes in family size (including marriage, divorce or having a baby)

In those circumstances, you may qualify for a special enrollment period. Check Healthcare.gov or talk with our patient advocate & insurance navigator, at 216-206-6538 for more details.

4. I found out that I’m no longer eligible for Medicaid and have to enroll in a plan through the Marketplace. I want a plan that lets me stay with my doctors at Westshore Primary Care—how do I make sure I choose the right plan?

If you’re no longer eligible for Medicaid coverage, you can enroll in a Marketplace plan during the special enrollment period. During this time it’s important to choose a plan that is in-network for Westshore Primary Care.

If you’re just starting the process to enroll in a plan through the Marketplace, contact our patient navigator, Sue Collins with Cuyahoga Health Access Partnership (CHAP) at 216-206-6538, or the billing department at 440-617-1823 extension 66406 to make sure you select a plan that will allow you to stay with us.

5. What Exchange/Marketplace plans are in-network at Westshore Primary Care?

Westshore Primary Care is a full in-network participating provider with the following Health Insurance Marketplace health plans:

  • Anthem
  • Health SpanOne
  • Medical Mutual SuperMed
  • SummaCare

6. Are there plans in the Marketplace that are not in-network for Westshore Primary Care?

We are not an in-network provider with the following health plans:

  • CareSource (Just4Me)
  • Molina Marketplace
  • Kaiser (Healthspan Integrated Care)

7. Can I still go to my doctor at Westshore if I have one of the out-of-network (CareSource, Molina, Kaiser) plans?

If you have an out-of-network plan, you will have to use the out-of-network (OON) benefits, which means you’ll be paying more for your care. You should check with your insurance provider for their policies related to out-of-network coverage.

If you have one of these plans, and have questions about your options please reach out to insurance navigator, Sue Collins at 216-206-6538. This is a free service and she will help you get a better understanding of the whole process and answer any specific questions.

8. Which hospitals in northeastern Ohio are in-network for CareSource Just4Me?

If you selected the CareSource Just4Me insurance policy as your qualified health plan offered through the Health Insurance Marketplace

9. Can I apply for Medicaid through the Marketplace?

The Marketplace application process will evaluate income and family size information to inform you of potential Medicaid eligibility. It is recommended at this time that applicants informed that they are eligible for Ohio Medicaid should apply through www.Benefits.Ohio.Gov 

10. Do you have additional questions or concerns about the changes associated with the Affordable Care Act or Health Insurance Marketplaces? 

Get free help and advice on navigating the system from our insurance navigator with the Cuyahoga Health Access Partnership (CHAP), Sue Collins at 216-206-6538.

DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. If you have a medical concern, please contact your doctor.

Photo Credit: "Question mark made of puzzle pieces” by Horia Varlan is licensed under CC BY 2.0

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