DID YOU KNOW? Social Media Series on ACA/Marketplace Insurance

DID YOU KNOW? If consumers believe there was a mistake or disagree with eligibility determinations made by a Marketplace, they have the right to request an appeal.

These determinations include:

• Eligibility to buy a Marketplace Qualified Health Plan (QHP), including a Catastrophic plan
• Eligibility for lower costs, including the amount of advance payments of the premium tax credit (APTC), and cost-sharing reductions (CSRs)
• Eligibility for a Special Enrollment Period (SEP) to enroll in a Marketplace QHP outside the regular Open Enrollment Period (OEP)

SOURCE: 2024 Truths and Myths 
DATE: Friday January 03, 2025

DID YOU KNOW? The ACA mandates that all insurance plans sold on the individual and small group markets cover essential health benefits (EHBs).

These benefits include:

• Services like hospitalization
• Prescription drugs
• Maternity care
• Mental health treatment
• Preventive care

By requiring these EHBs, the ACA ensures that consumers have access to comprehensive coverage.

SOURCE: www.hhs.gov/healthcare/about-the-aca/index.html
DATE: Saturday  January 04, 2025

DID YOU KNOW? Half of the public incorrectly believes that the law allows undocumented immigrants to receive financial help from the government to buy health insurance.

In fact, under the health law, undocumented immigrants remain ineligible for Medicaid and are ineligible for tax credits toward premiums for ACA Marketplace plans.

SOURCE: Data Note: 5 Misconceptions Surrounding the ACA | KFF
DATE: Monday January 06, 2025

DID YOU KNOW? 29% of the public incorrectly thinks that more Americans get health coverage through the ACA than an employer, Medicaid, or Medicare.

In fact, MOST Americans are insured through their employer, or a government program, such as Medicaid or Medicare.

Less than 10% of Americans are covered by ACA Marketplace plans.

SOURCE: Data Note: 5 Misconceptions Surrounding the ACA | KFF
DATE: Tuesday January 7, 2025

DID YOU KNOW? Many people misunderstand how their coverage works simply because of lack of clear definitions of these key terms:

• Premium - Amount you pay each month for your health care coverage
• Deductible - Amount you pay for covered services before your insurance plan starts to pay
• Copayment (copay) - A fixed amount you pay for a covered service AFTER meeting the deductible
• Coinsurance - Percentage of costs you pay AFTER meeting the deductible

These are referred to as “out-of-pocket costs,” meaning expenses for care that aren’t reimbursed by insurance.

Out-of-pocket max: Maximum amount you will pay during your coverage period, after which insurance pays 100%. (NOTE: Premium payments do NOT count toward out-of-pocket max.)

SOURCE: Your total costs for health care: Premium, deductible, and out-of-pocket costs | HealthCare.gov
DATE: Wednesday January 8, 2025

DID YOU KNOW? “Obamacare,” the Marketplace, and the “Exchange” are basically the same thing!

Lots of confusion about this but it’s really simple.

• Obamacare refers to the Affordable Care Act (ACA).
• The ACA created the Health Insurance Marketplace®, a service to shop, compare, and buy health plans.
• The “Exchange” is another name people use for the Marketplace.

And there you have it!

The ACA also created many protections for consumers including prohibiting denial of coverage for pre-existing conditions, more options for young adults, and more!

SOURCE: Understanding the Affordable Care Act (Obamacare) | eHealth
DATE: Thursday January 9, 2025

DID YOU KNOW? Most people who apply for coverage through the Marketplace qualify for savings!

Depending on your expected household income for the year, you may qualify for:

• Lower costs for your Marketplace plan, like the premium tax credit (PTC) that lowers your monthly premium
• Savings on out-of-pocket costs (like deductibles and copays) with cost sharing reductions (CSRs)
• Coverage through Medicaid or CHIP. Your kids may qualify for CHIP, even if you don't qualify for Medicaid.

SOURCE: Tips about the Health Insurance Marketplace® | HealthCare.gov 
DATE: Friday January 10, 2025

DID YOU KNOW? Since the implementation of the ACA, the rate of uninsured has dropped from 16% in 2010 to 7.2 percent in the most recent data!

Enrollment reached over 21M for the 2024 plan year—a record high since the launch of the ACA Marketplaces.

Health coverage, including public coverage, is important for financial security, dramatically improves health outcomes, and has wide-ranging and long-term benefits for children.

SOURCE: Record Marketplace Coverage in 2024: A Banner Year for Coverage | CEA | The White House
DATE: Saturday January 11, 2025

DID YOU KNOW? It isn’t necessary to wait until Open Enrollment each year to get new insurance if your circumstances change.

Consumers may qualify for a Special Enrollment Period (SEP) if they (or anyone in their household who is seeking coverage) lose qualifying health coverage.

Other reasons someone may qualify for a SEP include:

• Marriage
• Moving
• Having/adopting a child
• Leaving incarceration

View full list of qualifying events at HealthCare.gov

SOURCE: Getting health coverage outside Open Enrollment | HealthCare.gov 
DATE: Sunday January 12, 2025

DID YOU KNOW? Many incorrectly believe that a plan with the cheapest monthly premium is the best value.

In fact, while affordability is important, focusing solely on price can backfire. Cheaper premiums often mean higher deductibles, copayments (copays), and coinsurance, meaning you'll pay more out-of-pocket costs than you would with a higher premium plan.

Make sure you consider the plan's out-of-pocket max, your overall health needs, and risk tolerance when choosing your plan.

SOURCE: Health insurance myths debunked: Separating fact from fiction | HealthBird
DATE: Monday January 13, 2025

DID YOU KNOW? There’s a common misconception that insurance companies try to avoid paying claims.

In fact, while navigating claims can feel frustrating, reputable health insurance companies have a legal obligation to process claims fairly and efficiently.
Familiarize yourself with your plan's coverage details and keep clear documentation to ensure a smoother claims process.

If you're working with an agent/broker, they can track the progress and can advocate on your behalf to the insurance company, if needed.

SOURCE: Health insurance myths you might have heard | Blue Cross NC 
DATE: Tuesday January 14, 2025

DID YOU KNOW? Not all plan enrollments made during Open Enrollment will have a plan effective date of January 1.

Note the following important deadlines:

• Nov. 1: Open Enrollment starts. First day to enroll in, renew, or change health plans through the Marketplace for the coming year. Coverage can start as soon as Jan. 1.
• Jan. 1: Coverage starts for those who enroll in or change plans by Dec. 15 and pay their first premium.
• Jan. 15: Open Enrollment ends. Last day to enroll in or change plans for the year. After this date, consumers can enroll in or change plans only if they qualify for a Special Enrollment Period (SEP).
• Feb. 1: Coverage starts for those who enroll in or change plans Dec. 16 - Jan. 15 and pay their first premium.

SOURCE: 2024 Truths and Myths 
DATE: Wednesday January 15, 2025

DID YOU KNOW? Some consumers mistakenly assume they can be eligible for both Medicaid/CHIP and Marketplace coverage with APTC/CSRs.

In fact, consumers who are determined eligible for, or are enrolled in, coverage through Medicaid or the Children’s Health Insurance Program (CHIP) that counts as qualifying health coverage (AKA minimum essential coverage, or MEC) are ineligible for advance payments of the premium tax credit (APTC), and cost-sharing reductions (CSRs) to help pay for the cost of their Marketplace coverage premium and covered services.

SOURCE: 2024 Truths and Myths 
DATE: Thursday January 16, 2025

DID YOU KNOW? The guidelines re: who to include in your “household” on your Marketplace application

Include:

• Spouse (if you’re legally married)
• Anyone you'll claim as a tax dependent for the year you're seeking coverage
• Your spouse and dependents, even if they DON’T need health coverage

Do not include:

• If you WON’T claim them as a dependent, DON’T include them.

Limited exceptions:
Who’s included in your household | HealthCare.gov 

SOURCE: Who’s included in your household | HealthCare.gov
DATE: Friday January 17, 2025

DID YOU KNOW? Four in ten incorrectly think the ACA cut Medicare benefits.

However, while the ACA has reduced growth in payments to providers and to private health plans that participate in the Medicare Advantage program, it did not cut benefits for seniors enrolled in the traditional Medicare program.

SOURCE: Data Note: 5 Misconceptions Surrounding the ACA | KFF 
DATE: Saturday January 18, 2025

DID YOU KNOW? It’s important (and EASY) to update your Marketplace application

To make corrections, additions, or remove information:

• Log into your HealthCare.gov account and choose the application you want to update.
• Click “Report a Life Change” on the left-hand menu.
• Read through the list of changes and select “Report a Life Change.”
• Select the kind of change to report.
• Go through your application and report any changes to income, household, contact information, etc.
• When finished, you’ll get new eligibility results re: options to change plans (if applicable).

SOURCE: https://www.healthcare.gov/reporting-changes/how-to-report-changes/
DATE: Sunday January 19, 2025