Understanding the Health Insurance Marketplace

When can I enroll?

Starting October 1, 2013, you can apply for health insurance coverage. And you can find out about government subsidies that can make your premiums more affordable than ever.

The first open enrollment period is Oct. 1, 2013 – Mar. 1, 2014 (6-month period)

Important Dates to remember:

Oct. 1, 2013 – Open enrollment begins
Jan. 1, 2014 – Coverage begins
Mar. 31, 2014 – Open enrollment closes

Who is Eligible?

Many people will be eligible for health coverage through the Health Insurance Marketplace. To be eligible for health coverage through the Marketplace, you:

  • Must live in the United States
  • Must be a U.S. citizen or national (or be lawfully present)
  • Can't be currently incarcerated
  • Are not eligible for affordable health coverage through your employer

How can I be sure I am eligible?

Not only can you view and compare health insurance options online (www.healthcare.gov), but with one simple application, you can have those options tailored to your personal situation and find out if you might be eligible, based on your income, for financial assistance to lower your costs.

The same application will let you find out if you and your family members might qualify for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program (CHIP).

What will the plans cover?

Participating plans will cover doctor visits, hospital stays, preventive care, maternity care, emergency care and prescriptions. When you choose the MDWise exchange offer (which includes IU Health Goshen Hospital and providers), you get coverage for wellness visits, preventive care, education and more.

Coverage includes:

  • Pre-existing conditions
  • Pregnancy
  • Hospitalizations
  • Prescriptions
  • Doctor visits

How do I enroll?

There are 4 ways to apply.

Through CMS: Apply online at www.healthcare.gov. Or apply by phone by calling the CMS toll-free line at 800.318.2596, available 24 hours a day, 7 days a week. TTY users should call 855.889.4325 or apply by mail.

Locally: Apply in person with the help of a trained navigator at IU Health Goshen or Maple City Health Care Center. To make an appointment with an IU Health Goshen navigator, call 574.364.2383. Please remember enrollment begins Oct. 1, 2013.

What if I can’t afford health insurance?

Based on your income and family size, you may qualify for financial assistance. Individuals making up to $45,960 or a family of four making up to $94,200 may qualify for help paying their monthly premiums when they purchase health insurance through the Marketplace. Additionally, individuals making up to $28,725 or a family of four making up to $58,875 may qualify for additional assistance to help lower the amount they pay for out-of-pocket costs like deductibles, coinsurance and copayments.

How much will insurance cost me?

Monthly premium costs for the Health Insurance Marketplace are available through the online enrollment process.

My doctor(s) is/are part of IU Health Goshen. How do I make sure that I choose a plan that still covers them?

IU Health Goshen Hospital and IU Health Goshen area providers are part of the MDWise Marketplace. You will need to be sure that you select this plan when enrolling. At that time, you can verify if your provider is included.

To speak with a MDWise representative directly, please call 855.377.3654.

What can I do to prepare for enrollment?

  1. Make a list of questions. (Can I stay with my current doctor? Or how do I stay with my current doctor? What will my co-payments be? What services will be covered?)
  2. Gather info about your household income.
  3. Set your budget.
  4. Use IU Health Goshen as a resource. Call our toll free, 24-hour line at 877.566.4660. This 24-hour line is set up to help community members prepare for open enrollment. You can also use our website, iuhealth.org/goshen/enroll with 24-hour online chat. Additional community resources will be rolled out leading up to open enrollment and throughout the enrollment period. In the meantime, you can visit healthcare.gov/marketplace/individual for more information about how the program works.

I have insurance through my employer. Does this affect me?

If you are eligible for employer-sponsored health coverage, you are generally not eligible for the insurance product.

Whether or not you qualify for the Marketplace depends on what kind of coverage your employer offers. If your job-based coverage is considered “affordable” and meets minimum value, you won't be able to get lower costs on premiums or out-of-pocket costs in the Marketplace. This is true regardless of your income and family size. Employer coverage is considered affordable if the employee’s share of the annual premium for self-only coverage is no greater than 9.5% of annual household income.

I have Medicare. How will the Health Insurance Marketplace impact me?

Persons on Medicare stay in their current coverage and do not have a need for the Health Insurance Exchange products

What if I am self-employed? Do I qualify for health insurance through the Marketplace?

You could be eligible based on your annual income.

Where can I go for additional information?

For more information about the Health Insurance Marketplace and how to enroll, call 877.566.4660 or visit iuhealth.org/Goshen/enroll to find out about all of the advantages of choosing IU Health Goshen as your home for quality health care.

For more information, visit HealthCare.gov. Or, call the Health Insurance Marketplace Call Center at 800.318.2596, 24 hours a day, 7 days a week. TTY users should call 855.889.4325.