Healthcare Coverage Guide
Health insurance helps you pay for the healthcare you and your family need, like medicines and check-ups. The new healthcare law helps us get health insurance that is affordable and covers what we need.
The Health Insurance Marketplace
The Health Insurance Marketplace, a source of information about consumers' health insurance options as well as an enrollment portal for Pennsylvanians, is available at Healthcare.gov. Open enrollment this year begins Nov. 1, 2015 and ends on Jan. 31, 2016.
Important dates for coverage for 2016 - you must enroll by December 15, 2015 in order for coverage to be effective January 1, 2016
- Nov. 1, 2015: Open Enrollment starts — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as Jan. 1, 2016.
- Dec. 15, 2015: Last day to enroll in or change plans for new coverage to start Jan. 1, 2016.
- Jan. 1, 2016: 2016 coverage starts for those who enroll or change plans by Dec. 15.
- Jan. 15, 2016: Last day to enroll in or change plans for new coverage to start Feb. 1, 2016
- Jan. 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between Jan. 16 and Jan. 31 take effect March 1, 2016.
- No enrollment deadlines for the SHOP Insurance Marketplace (Small Employers).
- No enrollment deadlines for Medicaid or the Children's Health Insurance Program (CHIP). You can apply anytime.
If you don’t enroll in a 2016 health insurance plan by Jan. 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period.
For 2016 there are three plans offering a total of 29 products in Delaware County.9 (Assurant no longer offers products in Delaware County for 2016)
- AETNA: Crozer-Keystone is a tier 1 (low cost) provider and is participating in all Aetna products, including the new “LEAP” products offered on the health insurance exchange.
- Independence Blue Cross: Crozer-Keystone is a tier 1 (low cost) provider in Proactive products and is participating in all Independence Blue Cross products on the health insurance exchanges
- United HealthCare: United Compass products are limited network products and Crozer-Keystone is not a participating provider in United Compass
After you fill out an application with the Health Insurance Marketplace and provide household and income information, you’ll find out if you qualify for a premium tax credit that lowers your monthly health insurance bill.
You’ll also find out if, in addition, you qualify for “cost-sharing reductions.” This means you’ll pay less out of your own pocket when you get medical care, possibly saving hundreds or even thousands of dollars.
IMPORTANT: If you qualify for savings on out-of-pocket costs, you get them only if you enroll in a plan in the Silver category. You can enroll in any metal category you want, but you’ll get cost-sharing reductions only if you pick a Silver plan.
Use this quick tool to see if your 2016 income estimate falls in the range for cost-sharing reductions.
5 Things to Know About the Healthcare Law
- You can’t be denied because you’re sick or have been sick.
- All plans cover prescriptions, doctor visits and hospital care.
- You can find a plan that fits your budget.
- If you don’t have insurance, you may pay a penalty.
- You can get help to enroll in a plan.
The Health Insurance Marketplace is for people who don’t have health coverage.
If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage, the Marketplace can help you get covered.
- If you have job-based insurance: You can buy a plan through the Marketplace, but you’ll pay full price unless your employer’s insurance doesn’t meet certain standards. Most job-based plans do.
- If you have Medicare: You can’t switch to Marketplace insurance, supplement your coverage with a Marketplace plan, or buy a Marketplace dental plan. Learn about Medicare and the Marketplace.
Medicaid and the Children’s Health Insurance Program (CHIP)
Medicaid and CHIP provide free or low-cost coverage to millions of people and families with limited income, disabilities, and some other situations.
Many states are expanding Medicaid to cover all households below certain incomes. See if your state is expanding and if your income is in range to qualify. (Pennsylvania has expanded Medicaid Coverage)
Your children may qualify for CHIP even if you don’t qualify for Medicaid.
Get Ready to Apply
Applying for coverage is easy. When you're ready to enroll, make sure you know:
- Your household size
- Your income for 2016 (an estimate)
- If anyone in your family can get health insurance through an employee
- The names of your preferred doctors and hospitals
Our financial counselors are responsible for helping consumers - via phone call and on a walk-in basis at our hospitals - to learn about the basics of health coverage, identify and compare their coverage options and help them select health coverage that best fits their budget and specific needs.
Marketplace and Provider Quick Links
Government Contact Numbers
- Marketplace Call Center: 1-800-318-2596
- TTY: 1-855-889-4325
- Espanol: 1-800-318-2596
Health Plan Contact Numbers
Independence Blue Cross