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Frequently Asked Questions About Health Insurance

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Health Insurance for Children and Teens Ages 0 through their 19th Birthday

Health Insurance for Adults Ages 19-64 years old through the Marketplace


Health Insurance for Children and Teens Ages 0 through their 19th Birthday

Q. Why is healthcare important for kids and teens?

A: Healthy kids stay focused on learning, and are less likely to miss school days. Besides, being insured means less financial worries for the whole family.

Q: What are Medicaid and PeachCare for Kids?

A: Right from the Start Medicaid and PeachCare for Kids are two public health insurance programs for kids 0-19. Right from the Start Medicaid is a no-cost program. PeachCare for Kids can be no-cost, or may require a small monthly premium ($0-$35, with a maximum of $70 for two or more children). Premiums for PeachCare for Kids depend on your income and household size. Premiums must be paid monthly or coverage will be cancelled.

Q: What services do Medicaid and PeachCare for Kids cover?

A: Medicaid and PeachCare for Kids pay for doctor visits, immunizations, dental care, vision care, prescription medicines, hospital care, and much more.

Q: I have a job. Are my kids still eligible?

A: Yes, most children who are eligible for Medicaid and PeachCare for Kids, but are not enrolled are in working families. Working parents may not have health coverage through their jobs or the health coverage they get does not cover their children or the premiums paid qualify as “unaffordable.” In some cases, if you have private health insurance, and your income is very low, you and your children may still qualify for Medicaid and receive premium assistance.

Q: When can I enroll?

A: You can enroll anytime. The process can take up to 45 days, so get started now!

Q: My kids are teenagers. Are they still covered?

A: Yes. Medicaid and PeachCare for Kids cover kids until their 19th birthday. Eligibility is still determined by income and household size.

Q: Do non-U.S. citizens who are applying for Medicaid for their U.S.-born children have to prove
Citizenship or legal residency status?

A. No. If the person applying is not a U.S citizen and is applying for Medicaid for U.S. – born children, they are not required to provide proof of their citizenship status or present a Social Security card. Permanent Resident card-holder who have been in the US for 5 years or more may apply for Medicaid and PeachCare for Kids for their children.

Q:  How do I know if I am eligible?

A. Children under age 19 with household income up to $47,700 per year (for a family of four) may qualify for Right from the Start Medicaid or a household income of $58,932 (for a family of four) for PeachCare for Kids. It’s best to contact an enrollment assistance partner who can walk you through the process as eligibility limits may change.
Whether you work or not, your kids may be eligible. Many jobs don’t offer health insurance or it’s too expensive to cover your children. Kids and teens should stay enrolled as long as they qualify. You do need to renew their coverage every year, however.

Parents, grandparents and legal guardians can apply on behalf of their children.

Applying

You can apply on your own at compass.gov

OR you can get help applying through our enrollment assistance partners. They are ready to help!

What you Need to Apply

  • Birth certificate (Georgia-born residents do not have to have a copy to apply)

The Social Apostolate of Savannah may be able to help obtain out-of-state birth certificates for people who are in financial hardship. They are located at 502 East Liberty Street, Savannah, (912) 233-1877

  • Form of Government-issued Photo ID: e.g. Driver’s License, Passport (US or foreign) State issued identification card, Consular Identification Card
  • Social Security number for each child or proof that a card has been applied for.
  • Income documents (for one month- i.e. one month’s worth of paystubs or Form 809 for cash-only income from one employer or Form 126 – 3 months for cash-only self-employed income

Please consult with your enrollment assister on your particular situation.

Do I need to renew?

Yes. You will need to renew your coverage each year and will need to provide this information along with your renewal form each year.

What are Care Management Organizations?

CMOs or Managed care plans are a type of health insurance. They are health delivery organizations that have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. Presently, PeachCare for Kids and Georgia Medicaid health plans are managed by Peach State Health Plan, Amerigroup and WellCare of Georgia.

Go to PeachCare for Kids or Georgia Medicaid for more detailed information


Health Insurance for Adults Ages 19-64 years old through the Marketplace

The Affordable Care Act is working to make health care more affordable, accessible, and high quality for the people of Georgia. It puts individuals, families as well as small business owners in control of their health care. It reduces premium costs for millions of working families. It covers pre-existing conditions, requires preventive care to be fully covered and places a cap on out-of-pocket expenses.

To access the Health Insurance Marketplace website, click here.

Q: What is health insurance?
Health insurance is a contract between you and an insurance company. You buy a plan, and the company agrees to pay part of your medical costs when you get sick or hurt. Many companies offer free preventive care and cover some prescription drug costs.

Q: Who can get coverage through the Health Insurance Marketplace?
Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated. The Marketplace offers plans to individuals who do not have coverage through a job, Medicare, Medicaid, PeachCare for Kids or another source. The Marketplace is also for employed individuals whose health care plans are considered unaffordable (More than 9.66% of their gross income).

Q: Can I buy a plan on the Marketplace if I don’t have a Green Card?
If you are not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S., you are not eligible to buy a plan on the health insurance Marketplace. However, you can shop for health insurance outside of the Marketplace in the non-group market. Insurers outside of the Marketplace are prohibited from turning you down based on your health status or your immigration status and must follow generally the same rules as plans in the Marketplace.

Q: What is included in the health plans?
When you choose an in-network provider preventive services are covered at no cost for adults and children.
These include:
All qualified health plans offered in the Marketplace will cover essential health benefits. Categories of essential health benefits include:
• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including dental and vision care
The precise details of what is covered within these categories may vary somewhat from plan to plan.

Q: How do I know which plan is best for me?
The plans are placed into four categories: Bronze, Silver, Gold and Platinum. The categories do not indicate the quality or amount of care the plans provide. The categories affect your monthly premium costs and your total out-of-pocket costs. You can also use this Enroll America online tool to find the best health plan for you in your area based on your personal preferences.

Q: What is a deductible?
A deductible is the amount you owe for health care services before your plan begins to pay.

Q: How much does health insurance cost?
Usually there is a monthly premium for health coverage. There may also be a deductible each year before your insurance company starts to pay its share. A deductible may not apply to all services. The price of your plan will depend on which category you choose, Bronze, Silver, Gold or Platinum. Bronze plans will have the highest deductibles and other cost sharing, while Platinum plans will have the lowest. Health plans will also vary based on the networks of hospitals and other health care providers they offer. Some plans will require you to get all non-emergency care in-network, while others will provide some coverage when you receive out-of-network care. Many families and individuals will be eligible for some tax subsidies or premium tax credit.

Q: In Georgia, 9 out of 10 people qualify for help paying for their Marketplace insurance premiums. What is a premium tax credit (subsidy) and who qualifies?
Premium tax credits will be available to U.S. citizens and lawfully present immigrants who purchase coverage in the Marketplace and who have income between 100% and 400% of the federal poverty level. Premium tax credits are also available to lawfully residing immigrants with incomes below 100 percent of the poverty line who are not eligible for Medicaid because of their immigration status. (Generally, immigrants must lawfully reside in the U.S. for five years before they can become eligible for Medicaid.)
In addition, to be eligible for the premium tax credits, individuals must not be eligible for public coverage—including Medicaid, the Children’s Health Insurance Program, Medicare, or military coverage—and must not have access to health insurance through an employer. (There is an exception in cases when the employer plan is unaffordable because the employee share of the premium exceeds 9.66% of the employee’s income in 2016. There is also an exception in cases where the employer plan doesn’t provide a minimum level of coverage.)

Q: How do premium tax credits (subsidies) work?
Premium tax credits reduce your premium for most Marketplace policies. The amount of the tax credit you may receive depends on your income and the cost of Marketplace health plans in your area. The Marketplace will determine the expected contribution you are required to pay toward the premium for a mid-range (Silver) benchmark plan. The expected contribution will increase on a sliding scale based on your 2016 income. The difference between the premium for the benchmark plan and your expected contribution equals the amount of your tax credit. (You do not have to pay more than the actual premium for the plan.) The Marketplace will tell you what that dollar amount is. You can use that amount to help pay the premium for any Bronze, Silver, Gold, or Platinum plan offered in the Marketplace. The credit cannot be used to pay for a Catastrophic plan.
Premium tax credits may be claimed at the end of the year, or you can apply for an advanced premium tax credit based on your estimated income for the up-coming year. If you elect to receive an advanced credit, the government will pay 1/12 of the credit directly to your insurance company each month and the insurer will bill you for the rest of the premium.
It’s important to keep in mind that when you apply for the premium tax credit during Open Enrollment, you won’t necessarily know for sure what your income for the coverage year will be, so you will apply based on your best estimate. Later, when you file your tax return, the IRS will compare your actual income to the amount of premium tax credit you claimed in advance. If you underestimated your income and claimed too much premium tax credit, you might have to pay back some or all of the difference.

Q: How do I apply for premium tax credits?
On the health insurance Marketplace web site, you will find an Application for Health Coverage and Help Paying Costs. Filling out the application online is the fastest, though you can also submit a paper application or call your Marketplace call center and apply over the phone. The Application will ask you basic information about yourself (and any family members who are applying for coverage with you) including your Social Security number and information about your citizenship or immigration status. It will also ask employment and income information, including what’s on your most recent income tax return. Once you’ve submitted the application, the Marketplace will let you know if you qualify for help paying for Qualified Health Plans it offers. It will also let you know if you (or any members of your family) may be eligible for coverage through Medicaid or the Children’s Health Insurance Program.

Q: Can I cover my children in a plan on the Marketplace?
Yes, under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn age 26. Please check eligibility for Medicaid and Peachcare for Kids if you are children are under age 19.

Q: What if I am over age 26 and do not have insurance coverage?
There are special plans for young adults under age 30 on the Marketplace.

Q: Where can I go for help enrolling into the Marketplace?
By Telephone: 1-800-318-2596
Online: www.healthcare.gov
Licensed Navigators are available to assist at:
J.C. Lewis Primary Health Care Center 125 Fahm Street Savannah, GA 912-721-6726
Curtis V. Cooper Primary Health Care, Inc. 106 E. Broad Street Savannah, GA 912-527-1000

Q: Does my provider accept Marketplace plans?
It is best to speak with your provider to find out which plan is accepted at their office. You can also use this Enroll America online tool to find the best health plan in your area for you based on your personal preferences.

Q: I have health insurance through my job. Can I get a Marketplace insurance plan instead?
You can always shop for coverage on the Marketplace, assuming you meet other eligibility requirements, but if you have access to job-based coverage, you might not qualify for premium tax credits.

Q: I do not like the plan I selected. Can I change plans?
No. You are locked into that coverage for 12 months, or until the next Open Enrollment period. A change in health status doesn’t make you eligible for a special enrollment opportunity. You can switch to a different plan during Open Enrollment.

Q: I am uninsured. Am I required to get health insurance?
Everyone is required to have health insurance coverage – or more precisely, “minimum essential coverage” – or else pay a tax penalty, unless they qualify for an exemption. This requirement is called the individual responsibility requirement, or sometimes called the individual mandate.

Q: What’s the penalty if I don’t have minimum coverage?
In 2016, the penalty is the greater of
• $695 for each adult and $347.50 for each child, up to $2,085 per family, or
• 2.5% of family income above the federal tax filing threshold
In all years, the penalty is also capped at an amount equal to the national average premium for the median cost bronze health plan available through the Marketplace.
The penalty is assessed based on “coverage months.” This means that each month you are uninsured, you may owe 1/12th of the annual penalty. However, short spells of uninsurance may not be subject to a penalty.

Q: Are there exemptions to the penalty? If so, what are they?
Yes. You may be eligible for an exemption if you:
• Cannot afford coverage (defined as those who would pay more than 8.05 percent of their household income for the lowest cost bronze plan available to them through the Marketplace in 2015)
• Are not a U.S. citizen, a U.S. national, or a resident alien lawfully present in the U.S.
• Had a gap in coverage for less than 3 consecutive months during the year
• Won’t file a tax return because your income is below the tax filing threshold (For the 2015 tax year, filing threshold is $10,300 for individuals and $20,600 for married persons filing a joint return)
• Are unable to qualify for Medicaid because your state has chosen not to expand the program
• Participate in a health care sharing ministry or are a member of a recognized religious sect with objections to health insurance
• Are a member of a federally recognized Indian tribe
• Are incarcerated
Others who do not qualify through these categories but have experienced a hardship that makes it difficult to purchase insurance may apply through the health insurance Marketplace for an exemption to the individual responsibility requirement.

Q: On what grounds can I apply for the hardship exemption to the individual mandate?
People may apply for a hardship exemption if they have experienced difficult financial or domestic circumstances that prevent them from obtaining coverage – such as homelessness, death of a close family member, bankruptcy, substantial recent medical debt, or disasters that substantially damage a person’s property. In addition, a hardship exemption may be granted to people who were determined ineligible for Medicaid only because their state hasn’t expanded Medicaid coverage to residents with income up to 138% of the federal poverty level. (Note, most hardship exemptions must be obtained by applying directly to the Marketplace). However, the exemption for low income persons living in states that have not expanded Medicaid can also be claimed directly on the tax return.)
People may also apply for a hardship exemption if obtaining coverage would be so burdensome as to cause the applicant to experience other serious deprivation of food, shelter, or other necessities. Consult your Marketplace for more information about hardship exemptions.

Help enrolling in the Health Insurance Marketplace.
By Telephone: 1-800-318-2596
Online: www.healthcare.gov
Licensed Local Navigators are available to assist at:
J.C. Lewis Primary Health Care Center 125 Fahm Street Savannah, GA 912-721-6726 (Spanish-speaking assistance available)
Curtis V. Cooper Primary Health Care, Inc. 106 E. Broad Street Savannah, GA 912-527-1000 (Spanish-speaking in person assistance available)