BEYOND THE NUMBERS
Take Action to Get Health Coverage and Stay Covered
Some consumers may wonder whether to take steps to get and keep health plans under the Affordable Care Act (ACA), given continual news about Republican plans to repeal the ACA, but the clear answer is, yes, take action. These plans provide access to medical care that includes free preventive services. Otherwise, individuals and families can find themselves uninsured and exposed to financial risk from medical expenses as well as penalties under the ACA for not having coverage. Here are three steps that consumers may need to take to stay covered and secure access to medical care.
Pay Your Premiums
People enrolling in new marketplace health plans must pay their first monthly premium to complete the enrollment process in their plans. Those who signed up for marketplace plans after January 15 have to pay their premium for March coverage in accordance with their plan’s rules and timeframes. If they don’t make this payment, they’ll lose coverage and won’t be able to enroll in a marketplace plan until next year’s open enrollment period — unless they become eligible for a special enrollment period due to a major change in their life circumstances. Everyone enrolled in marketplace coverage must also continue paying their premiums throughout the year to stay covered.
Provide Required Documentation Some consumers may have to provide the marketplace documentation that proves their income, citizenship, or other factors relevant to their eligibility for marketplace coverage. This happens when the marketplace can’t verify these eligibility factors by data matches with Social Security and other records. If consumers don’t provide sufficient documentation, their plan could end or the subsidy they get under the ACA to help pay the monthly premium could change.
Generally, consumers in this situation can stay covered for about three months, during which they can send in their paperwork. When consumers don’t provide sufficient documentation on time, their coverage may end or their subsidy amount may change, making their premium unaffordable.
Read Mail About Coverage and Provide Appropriate Updates
Consumers must read carefully the mail and emails they get from their health plans and the marketplace so that they understand the steps they must take to maintain their coverage. They should also make sure to update the marketplace and their health plans with their best contact information including their mail, email addresses, and phone numbers so they can get timely notices about their coverage. Consumers must also let the marketplace know if they experience any other major change like gaining or losing a job or getting married.
Paying premiums, responding to requests for documentation, and keeping information current will help people stay covered and get the correct level of assistance throughout the coverage year.