Health Insurance Overview
Health care is expensive and few individuals can afford to pay the full costs. Having health insurance allows you to get the treatment you need without incurring huge medical bills.
Most Americans have private health insurance or participate in public programs, such as Medicare or Medicaid, but many Americans are uninsured due to finances and/or pre-existing conditions.
Under the Affordable Care Act, all Americans can get health insurance regardless of income or health history.
Open enrollment for 2014 coverage through the Health Insurance Marketplace is over. Generally, you can only buy Marketplace health insurance during open enrollment, but you may still be able to get health insurance if you qualify for a special enrollment period.
The Plan Finder can help you identify private plans outside of the Health Insurance Marketplace, but--unless you experience a qualifying life event--you won't be able to enroll until the next open enrollment period.
There is no limited enrollment period for Medicaid or the Children's Health Insurance Program. If you qualify, you can enroll at any time.
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States decide on the benefits provided under Medicaid, but Medicaid usually provides health care for low-income children and families, and people with disabilities. Covered services usually include doctor visits, hospital care, vaccinations, prescription drugs, vision, hearing, long-term care, and preventive care for children.
- State Medicaid Programs – Learn about the Medicaid program in your state, and how to apply. Note that if you're not eligible for Medicaid now, you may qualify in 2014, when new rules take effect in most states.
- Medicaid and the Health Insurance Marketplace – If you are eligible for Medicaid, you don't need to buy coverage through the Health Insurance Marketplace.
Medicare is a government health insurance plan for people 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease. Medicare helps to pay for care in hospitals, skilled nursing facilities, hospice care, and some home health care. Coverage can also include doctors’ services and prescription drugs.
Under the health care law, Medicare benefits have been expanded for preventive care and drug coverage. Medicare is not part of the Health Insurance Marketplace, so—if you have Medicare—you will not need to take any action as a result of the new Marketplace.
- Medicare – Learn about the Medicare program; enroll online; and find a Medicare-enrolled doctor or health care facility.
- Replace Your Medicare Card – If your Medicare card is lost, stolen, or damaged, you can ask for a new one online.
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COBRA: Keep Your Insurance If You Leave Your Job
The Consolidated Omnibus Budget Reconciliation Act (COBRA) can help you temporarily keep your health insurance even though you left your job. Eligibility for the program is based on the reason you left your job, and even if you get to keep your insurance, you may be required to pay the entire premium for coverage.
Starting in 2014, you may change from COBRA coverage to Marketplace health insurance coverage. Losing your COBRA coverage qualifies you to buy health insurance in the Marketplace, even if it's not during open enrollment. This is true whether your coverage runs out, or you choose to end it.
Health Insurance for Children: CHIP
The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for low-income children. Each state decides on the benefits provided under CHIP, but all states cover routine check-ups, immunizations, hospital care, dental care, and lab and x-ray services.
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How to Appeal a Health Insurance Claim
If your health insurer has denied coverage for medical care you received, you have the right to appeal the claim, and ask that the company reverse that decision. You can be your own health care advocate. Follow these five steps:
- Review your policy and explanation of benefits.
- Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).
- Request documentation from your doctor or employer to support your case.
- Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company's internal review process.
- If the internal appeal is not granted through step four, file a claim with your state's insurance department.
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