We will be updating this portion of our website on how to continue your policy as soon as more information becomes available. See below for Frequently Asked Questions regarding individual coverage.
To view the health insurance plans available to you at this time, you can contact the carriers offering coverage directly or visit healthcare.gov for an overview.
If you are eligible for a subsidy based on your income, you will need to apply through healthcare.gov. If you are not subsidy-eligible, you can apply directly through the health insurance carrier if they have that option available. If that option isn’t available, you will also need to apply through healthcare.gov.
The number of policies and insurance carriers that are available to you depend on what region you live in. Below is a brief overview for the Nashville area. To see what plans are available to you in a different region, please visit healthcare.gov/see-plans/.
FREQUENTLY ASKED QUESTIONS
The Affordable Care Act (ACA) includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Mandated coverage went into effect in early 2014.
Minimum essential coverage is defined as:
Minimum essential coverage does not include insurance consisting of excepted benefits, such as dental-only coverage.
Individuals with a religious exemption, unauthorized immigrants, and incarcerated individuals are exempt from the minimum essential coverage requirement. Click here to learn more and apply.
The Marketplace, also known as the health insurance exchange, is a new way to find affordable insurance coverage so no one is left uninsured. With one application, you can see all your options and enroll. Depending on your income and family size, you may be able to lower your costs on premiums when you purchase a private insurance plan through the Marketplace. You may also qualify for lower out-of-pocket costs or for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). You can also enroll directly through most health insurance carriers on their website or by phone.
Open enrollment is the window at the end of the year when anyone can apply for a major medical policy that will start January 1st. Outside the Open Enrollment Period, you can only enroll in a health insurance plan if you qualify for a Special Enrollment Period such as getting married, having a baby, or losing other health coverage.
All plans offered through the Tennessee insurance exchange will meet the ACA definition of a qualified health plan (QHP). QHPs are certified plans that provide a core set of benefits called essential health benefits, so consumers can compare plans on an apples-to-apples basis. Different plan categories will affect your monthly premium costs and what percentage you pay for things like hospital visits or prescription medications. The category also affects your total out-of-pocket costs—the total amount you’ll spend in a year if you need extensive care. Each of the categories offers the same essential health benefits. The categories don’t reflect the quality or amount of care the plans provide.
The Marketplace offers four categories of insurance plans: Bronze, Silver, Gold and Platinum. The categories are based on how much of the costs of care you pay, versus what the plan covers. The Bronze plan pays 60 percent, the Silver plan pays 70 percent, the Gold plan pays 80 percent, and the Platinum plan pays 90 percent.
The list of carriers who are offering coverage changes from year to year. You can view all of the carriers offering major medical policies on healthcare.gov, but you can also apply directly through the carriers' website.
If you think you may qualify for a subsidy you will need to enroll through healthcare.gov. If you don't qualify for a subsidy it can be easier to enroll directly through the carrier's website or by phone. Healthcare.gov allows you to see multiple carriers' plans at once but the application process can be more cumbersome. Additionally, some plans/networks may only be available directly through the carrier and not visible on healthcare.gov.
There are many different networks to select from. It is important to check that your current doctors accept the network you are looking to enroll in to ensure you won't have to switch to a different provider. You can do so by contacting your doctor's office or your insurance carrier.
The different health plans will meet a variety of needs and budgets. Some health plans will have lower monthly premiums and may charge you more out-of-pocket when you need care. Some will be higher-premium plans that cover more of your costs when you need care. Others will fall in between. All plans will cover the same list of essential health benefits. Based on your family’s income, you may be eligible for federal premium tax credits or additional cost-sharing reductions to help cover the cost of insurance. If you don’t have coverage in 2014, you may have to pay a fee. You can receive quotes for yourself or your family by going to healthcare.gov or calling an insurance carrier directly.
Individual/family policies automatically renew January 1st every year regardless of when you enroll. Rates for next year will be available through healthcare.gov and insurance carriers November 1st.
Subsidy eligibility depends on your family's total estimated yearly income. Click here to find out if you are subsidy eligible.
The amount you save depends on your family size and income. The lower your income, the higher your savings.
The penalty is the greater of a flat dollar amount per uninsured person OR a percentage of taxable household income. By year, those amounts are:
For children under 18, the penalties are half the adult amount. Beginning in 2017, the flat dollar amount will increase along with the cost-of-living adjustment. The flat dollar penalty is capped at 300 percent. Overall, the annual penalty is capped at an amount equal to the national average premium cost of a Bronze-level plan, which means you won’t be penalized at a rate higher than it would cost you to buy insurance.
A penalty will not be assessed on someone who:
Individuals may also be granted hardship waivers or be exempted on the basis of their religious beliefs.