Frequently Asked Questions

 

  1. What is the Community for a Healthy Exchange?

    The Community for a Healthy Exchange is a network of patients and caregivers dedicated to providing support for people who have questions about the coverage they have purchased through a health insurance exchange (or marketplace). The Community is also a resource to those who are have purchased exchange coverage and are having trouble accessing the health care services they need. The Community is a project of the Caregiver Voices United (CVU), a non-profit organization created to advocate for family caregivers who care for loved ones with chronic conditions, disabilities, disease, or the frailties of old age.

  2. What will be asked of me if I join the Community for a Healthy Exchange?

    The Community for a Healthy Exchange is exactly that—a community. By sharing your experience and ideas, as well as learning from the experiences and ideas of others, you can help raise awareness of the challenges many of us face and ensure all patients and their families have access to health coverage that really works for them. As a member of the Community for a Healthy Exchange, the most important thing you can do is share your personal experience with us and let others who might benefit know about our community as well

  3. What are the benefits of joining this community?

    As part of the Community for a Healthy Exchange, you will not only have the opportunity to improve your own individual experience, but also work as a community to help improve the lives and health of millions of other Americans.

  4. Why do you want me to share my personal story?

    Sharing your personal experience with the state health insurance exchanges is the first—and most important—step you can take as part of the Community for a Healthy Exchange. Your stories about your experiences with the exchanges will help us bring to light what the issues are, how many people are affected by them, and ultimately what we can do to resolve them, for everyone. Share your story here.

  5. What happens to my information when I share my story?

    Being willing to share your story will help us understand the issues patients and caregivers are facing in securing and using adequate health insurance through the health care exchanges. With your permission, we will share your story on the Community for a Healthy Exchange website so that  others can learn from, and benefit from, your experience..  From time to time, we askyou to share your story with your local media or other public audiences.  Click here to read our privacy policy.

  6. Are there other ways to get involved in the Community for a Health Exchange?

    Yes. While sharing your story is the most important step you can take in helping us about real life experiences, if you area uncomfortable doing so, there are other ways you can help, such as sharing your support for the Community for a Healthy Exchange on social media or telling people you know about the Community by email.

  7. Are the health insurance exchanges (also known as marketplaces) the same as healthcare.gov or ObamaCare?

    Yes and no. ObamaCare a term used for the Affordable Care Act (ACA)—the federal law that included the health care exchanges. The exchanges were set up to provide affordable coverage options for those who are uninsured but make too much money to qualify for programs like Medicaid, as well as for those already buying their own insurance. Healthcare.gov is the website for the exchanges in states where the federal government is running the exchange.

    No matter what state you live in, you can go to healthcare.gov to be directed to the appropriate place for you to buy insurance.  If you live in a state with a state exchange, healthcare.gov will direct you to your state’s website so you can secure coverage. You can also access your state’s website directly, without having to go through healthcare.gov.  If you live in a state that has elected not to set up a state exchange, you will be able to choose a state-specific health plan directly on healthcare.gov. Click here for more information about which states have what type of exchange.

  8. Where can I go to get help understanding the health plan I or my family member has purchased through our state Health Insurance Marketplace?

    The first place you should go is either healthcare.gov or your state exchange website and look for “frequently asked questions” (or something similar).  If, however, you find these resources don’t meet your needs, you can find resources in your area by visiting the healthcare.gov "Local Help" page (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange) for information on how to contact a live representative for help answering your questions.  These representatives, also known as health care  “navigators,” can help you figure out how to proceed.

  9. What is the difference between the Bronze, Silver, Gold, and Platinum plans?

    Each type of plan has different premiums, cost-sharing, coverage, and other characteristics associated with it. In fact, even plans within the same metal level will most likely differ from one another metal level.  Picking the type of plan that works for you is one of the most important decisions you’ll make. You should be as informed as possible about the plans before making your decision. Click here for more information about different types of plans.

  10. Are there any tools available for comparing coverage options?

    While many Health Insurance Marketplaces provide some resources to help you compare plans and find the best one for you or your loved one, the fact is that many of these tools are not as user-friendly as they could be. This is one of the key challenges we are discussing in the Community for a Healthy Exchange.  We encourage you to visit healthcare.gov or your state exchange page for more information, and, when you are selecting a health plan. Be sure to research as carefully as possible in order to understand what all your costs may be, beyond just the premium, given your or your family member’s individual health care needs. 

  11. How can I get help figuring out which health coverage plan is best for me or the person I’m caring for?

    The best place to start is healthcare.gov or your state exchange, where you can access frequently asked questions and communicate directly with representatives of your state’s exchange. If, however, you find these resources don’t meet your needs, you can find resources in your area by visiting the healthcare.gov "Local Help" page (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange). These resources include health care  “navigators” who can help you figure out how to proceed.

  12. What is a navigator and how can they help me?

    A health care “navigator” is someone who works with the state exchanges and has been trained to help to patients and caregivers “navigate” the system when trying to select a health plan. Visit the healthcare.gov "Local Help" page to find Navigators and other resources in your area (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange).

  13. Are there any organizations in my community that offer support and resources for navigating the state Health Insurance Exchange?

    It depends on your community. One of your best bets is a health care “navigator,” who can help you “navigate” the system when trying to secure health insurance through a health care exchange. Visit the healthcare.gov "Local Help" page to find navigators and other resources in your area (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange).  

    Your state insurance commission may also offer resources or be able to direct you to additional resources in your area.  Visit the National Association of Insurance Commissioners website[RAD1]  to find your state’s insurance commission.

  14. Who should I contact about the challenges I’m facing with my health coverage?

    The best place to start is healthcare.gov or your state exchange, where you can access frequently asked questions and communicate directly with staff. If, however, you find these resources don’t meet your needs, you can find resources in your area by visiting the healthcare.gov "Local Help" page (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange). These resources include health care “navigators” who can help you figure out how to proceed.

    Your state insurance commission may also offer resources or be able to direct you to additional local resources, depending on the nature of your questions.  Visit the National Association of Insurance Commissioners website to find your state’s insurance commission.

  15. Can insurers deny me coverage because I have an existing medical condition?

    No. In fact, requiring coverage despite existing medical conditions was a major reform included in the Affordable Care Act (ACA, aka “ObamaCare”). So, at a minimum, health plans must treat pre-existing conditions and cover certain essential health benefits, including:

    • Ambulatory patient services
    • Emergency services
    • Hospitalization
    • Maternity and newborn care
    • Mental health and substance use disorder services
    • Prescription drugs
    • Rehabilitative and habilitative services and devices
    • Laboratory services
    • Preventive and wellness services and chronic disease management
    • Pediatric services

       

  16. The exchange health plan I was enrolled in during 2015 limited my access to medicines and/or providers that I need. What can I do?

    You may sign up for a different plan during this open enrollment period. The open enrollment period starts November 1, 2015 and runs through January 31, 2016. Visit healthcare.gov or your state exchange website for more information or to begin changing your plan for the next year.

    You can also share your experience with our community, learn about others’ experiences, and share your ideas for ways in which we can help ensure all patients and caregivers are better able to access coverage that really works for them.  Raising awareness is a critical part of making sure we solve the challenges long-term, for everyone’s benefit.

  17. What can I do if my coverage is not working for me?

    You may sign up for a different plan during this open enrollment period. The open enrollment period starts November 1, 2015 and runs through January 31, 2016. Visit healthcare.gov or your state exchange website for more information, or to begin changing your plan for the next year.

    Some individuals and/or families are also allowed to change their plan outside the open enrollment period if they qualify for a “special enrollment period,” usually based on life events like the birth of a child or loss of other health care coverage. Click here for more information on special enrollment periods in the federal exchange. For state exchange information, visit your state exchange website. 

    We also encourage you to share your experience with our community, learn about others’ experiences, and share your ideas for ways in which we can help ensure all patients and caregivers are better able to access coverage that really works for them.  Raising awareness is a critical part of making sure we solve these challenges long-term, for everyone’s benefit.

  18. I’m a caregiver. How can I help a family member who is facing challenges with their health coverage?

    The best place to start is healthcare.gov or your state exchange, where you can access frequently asked questions and communicate directly with staff. If, however, you find these resources don’t meet your needs, you can find resources in your area by visiting the healthcare.gov "Local Help" page (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange). These resources include health care “navigators” who can help you figure out how to proceed.

    Your state insurance commission may also offer resources or be able to direct you to additional local resources, depending on the nature of your questions.  Visit the National Association of Insurance Commissioners website to find your state’s insurance commission.

  19. What if I or my family members can’t afford their health plan premiums?

    The health care exchanges include two options for those who cannot afford their premiums: cost-sharing subsidies and premium tax credits. Cost-sharing subsidies help by lowering monthly out-of-pocket expenses, such as co-pays and coinsurance.  They are available to individuals and families making between 100 and 250% of the federal poverty level (FPL) (about $12,000-$29,000 for an individual or $24,000 to $60,000 for a family of four) who are enrolled in a silver plan.  The premium tax credit subsidizes qualifying enrollees’ monthly premiums and are available to those from 100% to 400% FPL (about $12,000 to $47,000 for an individual or $24,000 to $95,000 for a family of four). Eligibility for both programs is based on need factors, such as income and a lack of an affordable offer of coverage through an employer .

    Visit healthcare.gov or your state exchange to contact a representative who can help you determine if you are eligible for this type of assistance. The Kaiser Family Foundation also offers a subsidy calculator you can use to calculate your eligibility online.

  20. My coverage costs are more than I anticipated. How can I find out if I am I eligible for subsidies or cost-assistance?     

    You can get assistance figuring out your eligibility by visiting healthcare.gov (if you are in a federal exchange or partnership state) or be directed to your state page (if you live in a state with an exchange). The Kaiser Family Foundation also offers a subsidy calculator you can use to calculate your eligibility online.