Essential Spotlight


January 1 directly to your insurance company. Coverage is not guaranteed until this payment is made.


Things to consider when making your selection:


1.Whether your providers are “in net- work” with the plan and which doctors and hospitals are available to you.


2.Are any medications that you currently take covered on the health plan’s drug formulary?


3.Compare copays, deductibles, coin- surance and maximum out-of-pocket costs. These costs are separate from the monthly premium, but you want to consider the whole picture.


4.Does the plan cover all services you are currently using? Review the Summary of Benefits on the health plan’s website to find out.


W


Thinking about Health Insurance for 2019? Healthcare.gov is the website of the


e all make many important deci- sions in life and choosing health insurance coverage is one of


them. According to the Institute of Medi- cine, health insurance coverage matters in terms of both the quality and the duration of life. Here are some things you should know before making this important choice:


Open Enrollment for 2019 health in-


surance plans is from November 1 through December 15. After the December 15 deadline, individuals and families will have to meet specific criteria to qualify for a Spe- cial Enrollment Period to obtain coverage through the Health Insurance Marketplace.


Advanced Premium Tax Credits (APTC) and Cost-Sharing Reductions help make healthcare coverage more affordable for many Maine people who are income and otherwise eligible.


You can enroll in an individual/family health plan in several ways:


• Through Healthcare.gov – the Health Insurance Marketplace;


• Through an insurance agent, a local navigator or certified application counselor; or


• Directly from a health insurance com- pany like Community Health Options.


12 ELM™ Maine - November/December 2018


Health Insurance Marketplace. You can use it to review plan offerings for 2019 and see if you qualify for APTC (premium subsidies) and Cost-Sharing Reductions (lower co- pays, deductibles, and out-of-pocket costs). You’ll need an email address to begin the process.


To enroll:


1.Create your account on healthcare.gov to find out if you qualify for a tax credit. You sign up and answer a few questions; they email you with the results.


2.Collect information including your social security number, recent pay- stubs, W-2s, tax returns, and current job information for each working person in your household, needed to complete your application.


3.Apply for coverage. Begin by clicking “Get Coverage” on the Healthcare.gov website. Take your time and make sure you understand terms and concepts.


4.Select a plan. It’s not over until you see that final confirmation screen to be sure you’re enrolled.


5.Make the first binding payment either immediately on the website or by


5.Does the insurance company offer any programs to help with your, or your family members’ special health needs? For example, some Commu- nity Health Options plans include a Chronic Illness Support Program (CISP) that offers some reduced or no-cost benefits on certain prescriptions and select medical services for Members with Diabetes, Asthma/COPD/Emphy- sema, Coronary Artery Disease and/or Hypertension.


Premium Tax Credits and other Cost Sharing Reductions may make coverage more affordable. You may be eligible for the cost-sharing reductions depending on income, household size, and the plan that you pick. In 2018, an eligible individual in a household of one who earned between $12,060 and $48,240 could expect some level of Advanced Premium Tax Credits. Ranges for 2019 are expected to adjust up slightly.


The proposed implementation of Medicaid Expansion would make some Mainers who apply eligible for the Main- eCare (Medicaid in Maine) instead of Marketplace plans but details of Medicaid expansion are still being debated so stay tuned for details.


Assisters can help you with your deci-


sions and even help you to enroll. Certified Application Counselors and Navigators (“Assisters”) are trained to help find a health plan that fits your needs. Consum- ers for Affordable Health Care (CAHC) op- erates a hotline (800-965-7476) to answer questions and can also direct consumers to Assisters to schedule an in-person meeting. Act quickly, as these Assisters may book


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