Why is health insurance important?

Updated:Apr 11,2014

Insurance Information GraphicHealth Insurance Marketplaces Now Open: New Health Insurance Marketplaces are open in every state that will provide one-stop shopping for health insurance for individuals, families, and small employers needing coverage. To find the Health Insurance Marketplace for your state, visit www.healthcare.gov or call toll-free at 1-800-318-2596.

Eligibility: Individuals who need coverage who are legally residing in the U.S. and who are not incarcerated are eligible to purchase coverage through their state’s Marketplace. Small employers with fewer than 50 full-time employers can also purchase coverage through the Marketplace. Insurance companies will not be allowed to deny coverage to individuals with pre-existing medical conditions nor will they be allowed to charge higher premiums to people because of their health status.

Financial Assistance Available: Most uninsured individuals will qualify for financial assistance called a Health Insurance Premium Tax Credit to help make their insurance premiums affordable. The amount of financial assistance will depend on your income and family size. Individuals with low incomes may qualify for free or very low premiums. To find out how much financial assistance you may qualify for, check out the Kaiser Family Foundation’s subsidy calculator

Types of Coverage: All of the health plans sold through the Marketplace are offered by private insurance companies and are required to meet minimum requirements. All of the plans are required to cover a comprehensive set of benefits that includes hospital care, doctors’ visits, emergency care, prescription drugs, lab services, preventive care, and rehabilitative services. Before choosing a plan, individuals will be able to see whether their healthcare practitioner participates in the plan’s network (if choosing a network plan). Individuals will be able to choose the plan that best meets their needs and budget. Individuals with low-incomes may instead qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program. 

How to Enroll: Individuals who need coverage can fill out a single application to find out what financial assistance they are eligible for and to apply for coverage. To find your state’s Marketplace and to apply online go to www.healthcare.gov. Individuals can also call toll-free 1-800-318-2596 to apply. Those needing assistance with filling out the application can get help from trained, certified counselors; to find in-person assistance near you, contact your state’s Marketplace or visit www.healthcare.gov.

The next open enrollment period will begin on November 15th, 2014 and end on February 15th, 2015. However, in certain circumstances, you may be able to buy coverage outside of the regular open enrollment period, such as if you:

  • Have or adopt a baby, or
  • Get married, or
  • Move to a new state, or
  • Lose your other health insurance coverage.
Additionally, those who qualify can apply for the Children’s Health Insurance Program (CHIP) or Medicaid at any point during the year. There is no open enrollment period for these programs. Also, if you own or operate a small business, you can begin offering coverage to your employees at any time.

 

If you have heart disease or stroke, health insurance can help. You’re more likely to get the care you need, have shorter hospital stays and get healthier compared to people without health insurance. 

Heart disease and stroke can be very expensive; in fact they are leading causes of medical bankruptcy. Health insurance can help you avoid being stuck with large medical bills. 

If you have health insurance you can:

  • Go to the doctor for preventive services and get the care that you need to stay healthy and prevent serious illnesses;
  • Be treated sooner if you or one of your family member get sick or diagnosed with a heart condition; and
  • Avoid having the condition worsen.

Understand Your Options

Health insurance can be confusing and overwhelming. The good news is that there are several resources that can help you understand and compare health plans:

  • Summary of Benefits and Coverage: If you have a private health plan, you should get a standardized, easy-to-understand form called the Summary of Benefits and Coverage. You can use it to help you compare different insurance options.  Ask your insurer for it if they don’t provide it.

    To see a sample of this short form and learn more about how it can help you, Consumer Reports magazine has developed this helpful guide.
     
  • Glossary of Health Insurance Terms: The U.S. Department of Health and Human Services has developed a glossary of common insurance terms, such as deductible, copayments and out-of-pocket limits.

Reading up about health insurance can take a little time, but it will pay off — for your heart health!

Paying for Health Care or Health Insurance

Starting October 1, new financial assistance called the Health Insurance Premium Tax Credit will be available to help make insurance premiums affordable for those who need coverage. The website Healthcare.gov will provide a single location where you find out whether you are eligible for the premium tax credit and shop for and compare the different health insurance plans available to you in your state. Check out Healthcare.gov if you would like to learn more about the new options available October 1 and what you need to do to get ready. Meanwhile, if you need coverage immediately and would like to search for and compare plans available now, go to finder.healthcare.gov to start your search.

Some hospitals, health centers and clinics provide medical care, prescription drugs, dental care, and other services regardless of your ability to pay. Anyone may use a community health center, whether you have health insurance or not. How much you pay will depend on your income. Find a community health center near you.

The Foundation for Health Coverage Education’s website, also includes state-by-state information on different coverage options or sources of financial assistance that may be available to you.

Learn more:  Also in this section:

Consumer Health Care

Hearts for Healthcare

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The Affordable Care Act is helping to make health care coverage from accessible and affordable to millions of Americans. Learn what the law means for heart disease and stroke patients and their families.

The YouToons Get Ready for Obamacare (Kaiser Family Foundation)

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Watch the video and get ready today!