Tips about the Health Insurance Marketplace

For coverage beginning January 1, 2023, enrollment ends December 15, 2022. Open enrollment ends January 15, 2023.

Requirements to be eligible to enroll in Marketplace health coverage: live in the United States, be a U.S. citizen or national (or lawfully present), and not be incarcerated.

You are eligible for two types of coverage, depending on your income:

A tax-credit health plan.
Coverage through Medicaid/Children’s Health Insurance Program (CHIP).

All plans cover:

Outpatient ambulatory services (outpatient care you receive without being admitted to a hospital).
Emergency services
Hospitalization (such as surgery and overnight stays)
Pregnancy, maternity and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitation and habilitation services and devices (services and devices to help people with injuries, disabilities, or chronic illnesses gain or regain mental and physical abilities)
Laboratory services
Pediatric services, including oral and vision care (but dental and vision coverage for adults are not essential health benefits)
Pre-existing conditions: Insurance companies cannot refuse to cover treatment for your pre-existing condition or charge you more.

Medicare and home health care

If your doctor indicates that you need home health services, you may choose an agency from the list of Medicare-certified participating agencies that provide services in your area. These agencies are certified to ensure that they meet certain Federal health and safety requirements.

Your physician, hospital discharge planner, and other referring agencies must accept the agency you choose. Although you choose, your options may be limited by agency availability, or by insurance coverage. If you have a Medicare Advantage Plan (such as an HMO or PPO) or other Medicare health plan, you may be required to use one of the agencies that contract with them. Call your plan for more information.

In general, as a Medicare beneficiary receiving services from a Medicare-certified home health agency, you have certain rights including the right to:

Get a written notice of your rights before care begins
Have your home and property respected
Be told in advance what kind of care you will receive and when your plan of care will change.
Participate in your plan of care and treatment.
Get written information about your privacy and appeal rights.
Have your personal information kept confidential
Get information orally and in writing about what Medicare is expected to pay and what you are responsible for paying for services
File a complaint about the quality of services and to have the agency follow up on your complaint.
Know the phone number for your state’s home health hotline to call if you have a complaint or a question about the services you are getting.

At the following link https://www.medicare.gov/sites/default/files/2020-10/10969-S-Medicare-and-Home-Health-Care.pdf , you can learn more about:

Who is eligible for this benefit?
How Medicare Pays for Home Health Care
What Medicare covers
What you pay
“Advance notice of non-coverage to the beneficiary”.
Your right to an expedited appeal
Find a Medicare-certified agency
Agency Checklist
Specific rules for home health care agencies
More information about home health care agencies
Your plan of care
Your rights as a Medicare beneficiary
Where to File a Complaint About the Quality of Your Home Health Care
Home Health Care Checklist
Help with your home health care benefit questions
What you should know about fraud

For more information click here

Tips about the Health Insurance Marketplace