Frequently Asked Questions
The Affordable Care Act (ACA), also known as "Obamacare," requires most people to have health insurance, which can be obtained from a marketplace of health plans through state and federal exchanges.
Generally speaking, people may only enroll during a period called “Open Enrollment”, which takes place from November through January each year. However, individuals who have gone through a significant life change (such as moving, marriage, birth of a child, or loss of existing coverage) may be eligible to enroll outside of the Open Enrollment period, called Special Enrollment. Applicants who may qualify for coverage through Medicaid may apply at any time during the year.
Below are common questions asked about the Affordable Care Act.
Health plans available through the exchanges vary from region to region for each state. The simplest way to check is to review “Dignity Health Insurance By Region” for California or Arizona. Find the region your county is in, and then check the list of regions to see which health plans align with Dignity Health physicians and facilities in 2017.
It's a good idea to confirm your doctor and your hospital of choice are covered by your new insurance for the upcoming year by checking the insurance website or calling your insurance carrier directly. Do not assume your physician is covered without checking first. Doctors and hospitals may periodically change the insurance they accept. Review "Dignity Health Insurance By Region" for California or Arizona which will allow you to see Dignity Health doctors and visit Dignity Health facilities.
You can also call and speak to a Dignity Health referral representative who can help:
- California: 888.628.1954
- Arizona: 866.600.1065
- Nevada: 888.628.1951
The Health Insurance Marketplace (sometimes known as the Health Insurance Exchange) is a way Americans can compare and shop for health insurance. Some may even be able to get help paying for that insurance.
Depending on where you live, your Health Insurance Marketplace will be run by the state or by the federal government. In California, the exchange-Covered California-is run by the state, while Arizona and Nevada have chosen to participate in the federal government exchange, healthcare.gov.
To be eligible:
- You must live in the U.S.
- You must be a U.S. citizen or national, or a lawful resident.
Even if you don't qualify because you are not a U.S. citizen, other members of your family might be eligible for coverage. There is no penalty for applying, and your information will not be used for any purpose other than determining if you and your family members qualify for health coverage.
Also, health plans available through the Health Insurance Marketplace aren't the only new form of coverage available. Even if you cannot afford to purchase insurance through the exchanges, you may still qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). Even now, many Americans who qualify for these programs are not currently enrolled.
As of 2014, most people are required to have a basic level of health coverage. If you go without it for more than three months in a row, you may have to pay a tax penalty when you file your taxes the following year. Some people, however, don't have to buy insurance, based on their income or other status. If you think you may be exempt from needing coverage, check healthcare.gov.
You have many ways to apply: in person, over the phone, or online. If you would like assistance, the state and federal exchanges have certified enrollment assistance available both in person and over the phone. Assistance is available at no cost to you. Insurance Experts offer information about the health coverage available in your area and the application process for your state. If you prefer to apply directly online, you can complete the application process at coveredca.com (for California) or healthcare.gov (for Arizona and Nevada). Even if you decide to apply directly online, Dignity Health's ACA Help Center has valuable resources to help make the process go smoother.
Unless you have a "qualifying event," you can only buy individual or family health coverage during the annual Open Enrollment period. Applicants who may qualify for coverage through Medicaid may apply at any time during the year. The Open Enrollment period begins in November and ends in January each year. "Qualifying events" that enable a person to obtain coverage outside the Open Enrollment period, also known as the Special Enrollment Period, include getting married, having or adopting a child, changing one's residency, losing health coverage, or turning 26 years old (i.e., becoming no longer eligible to stay on your parents' plan). Such individuals may apply for coverage within 60 days of the event.
Once you've enrolled, coverage will begin the first of each month as long as you have enrolled by the 15th of the previous month. If you enroll after the 15th of the month, coverage will begin on the first of the following month. For example, if you enroll for coverage on Dec 15, your coverage will go into effect on Jan 1. If you enroll for coverage on Dec 16, your coverage will go into effect February 1.
It doesn't cost anything to apply and learn what coverage options you qualify for, what they will cost, and what financial help you can receive. Once you know your options, you can decide what health insurance plan is best for you and your budget.
If you enroll in a plan through the Health Insurance Marketplace, you may be eligible for financial assistance. The amount of money you would have to pay each month depends on your income. The same application used to determine the coverage options you qualify for will also tell you how much financial help you can get.
Medicaid is a health coverage program that exists in every state. In California the program is called Medi-Cal. States set the rules about who can enroll in Medicaid. In the past, coverage has been mostly limited to low-income children, their parents, pregnant women, and people with disabilities. But in January 2014, many states, including California, Arizona, and Nevada expanded coverage under Medicaid and allowing more people to enroll.
One application will be used to determine eligibility for coverage through the Health Insurance Marketplace, and for Medicaid and the Children's Health Insurance Program (CHIP). The same application will help every member of the household determine what coverage and financial assistance they are eligible to receive.
Health insurance plans are sold in four primary levels of coverage: Bronze, Silver, Gold and Platinum. They present a range of options. At one end is Bronze, with the lowest monthly premium, but with higher copays and deductibles when you need medical care. At the other end is Platinum, in which enrollees pay higher monthly premiums but pay less when they need medical care. You can choose the level of coverage that best meets your health needs and budget.
The breakdown of costs for the standard Bronze, Silver, Gold and Platinum health plan levels is as follows:
- Bronze: On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent.
- Silver: On average, your health plan pays 70 percent of your medical expenses, and you pay 30 percent.
In some cases, individuals may qualify for an Enhanced Silver plan based on their income, which enhances savings through lower copays, coinsurance, and deductibles in addition to a lower monthly premium cost.
- Gold: On average, your health plan pays 80 percent of your medical expenses, and you pay 20 percent.
- Platinum: On average, your health plan pays 90 percent of your medical expenses, and you pay 10 percent.
In addition, there is a minimum coverage plan for those who qualify:
- Minimum coverage plan: If you're under 30, you may be able to buy a health insurance plan option called minimum coverage plan, also known as a "catastrophic" plan. These plans usually have lower premiums and mostly protect you from worst-case scenarios. Minimum coverage plans cover three doctor visits or urgent care visits, including outpatient mental health/substance use visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until you spend $6,850, after which all in-network services are covered at 100 percent.
Call and speak to a Dignity Health referral representative who can help you find the right doctor:
- California: 888.628.1954
- Arizona: 866.600.1065
- Nevada: 888.628.1951
You can also visit dignityhealth.org/doctor to find Dignity Health providers in your area.
It's important to check that the doctor you choose accepts your health plan. Be sure your doctor knows what health plan you have when you make an appointment.
Whether you purchased coverage during Open Enrollment in the last year or two, or you began coverage due to a qualifying event in between Open Enrollment periods, it's a good idea to assess your coverage each year. The Open Enrollment period, which generally begins in November and runs through January, is the only time you can make a change unless you have a qualifying event like getting married, moving, or having a child. The health plan options available in your area can change each Open Enrollment. By taking the time to shop around you may find a carrier or plan which will cost less each month or less when you access services. A certified enrollment expert can help you determine your needs so your plan provides the right amount of coverage for you and your family. Speak with an Insurance Expert for more information on what you may qualify for and how to get connected to enrollment assistance.
Before you decide to change plans, be sure to check whether your doctor will accept the new coverage as not all doctors and hospitals accept all plans.
Depending on whether your income has increased or decreased, your subsidy-eligibility status may change. Either way, it's a good idea to check so you don't end up owing money due to receiving too much subsidy or not enrolling in a plan which will save you the most on out-of-pocket costs. An Insurance Expert can help you find out and ensure you are in the best plan to fit your health care needs as well as your budget.