Healthcare.gov Premium Tax Credits and Filing Your 2022 Taxes
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If you currently do not have health insurance, we can help! Click here to learn more and make an appointment with a health insurance navigator today.
Health insurance on Healthcare.gov is affordable for many people because the government subsidizes your monthly premiums based on your income. These subsidies are called Premium Tax Credits. If you receive them each month during the year, they are called Advance Payments of the Premium Tax Credit (APTCs).
If you receive these government subsidies, you need to reconcile these payments on your tax return each year. The IRS requires you to do this to make sure that you received the proper amount of subsidies based on your income.
Use Form 8962 to see how much premium tax credit you qualify for based on your actual year-end income. If your income at the end of the year is higher than you estimated on your Healthcare.gov application, you will need to pay back some of your subsidies. This is because you were given more subsidies than you were qualified for, based on your annual income.
If your income at the end of the year is lower than you estimated on your Healthcare.gov application, you may be eligible for a refund. Use form 8962 to claim the Premium Tax Credit.
How do I know if I received APTCs?
If you enrolled yourself or a family member in a Healthcare.gov plan, you will receive Form 1095-A from the Health Insurance Marketplace. This form will show the months that you were covered by a Healthcare.gov plan and will show the amount of APTC that was paid to your health insurance company on your behalf. The Marketplace also provides this information to the IRS.
Are there changes for filing taxes in 2022? What do I need to do?
If you received excess APTCs in 2022, you will be required to pay these back when you file your tax return.
If you find on Form 8962 that you received a smaller amount of subsidies than you qualify for based on your year-end income, you may claim the Premium Tax Credit on form 8962.
The deadline to file your 2022 federal income tax return is April 18, 2023. If you do not reconcile your APTCs by filing your 1095-A on your 2022 tax return, you run the risk of not being eligible for APTCs in future years.
No Surprises Act: Protecting patients from surprise medical bills
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The No Surprises Act protects people from “surprise medical bills.” These protections apply to anyone enrolled in a private health insurance plan, including employer plans or a plan purchased on or off the marketplace. New protections were added in 2022 to restrict excessive out-of-pocket costs from emergency and non-emergency services. If you’re uninsured or you decide not to use your health insurance, these protections allow you to get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges.
Even though surprise bills are now banned in many circumstances, enrollees should monitor their medical bills because they might need to take action to protect their rights. Note: Most of the law’s protections only apply to people with private insurance, and not to people who are uninsured or enrolled in Medicaid, CHIP, or Medicare.
New protections for insured patients
The new law protects insured people in two major ways:
For emergency care: An insured person can get care at any emergency department, even if the care is out of network. The out-of-network emergency facility, and the doctors and other providers who treat the patient, cannot bill the patient for more than in-network cost-sharing amounts (i.e., deductible, copay, coinsurance). The plan also must apply only in-network cost-sharing.
For non-emergency care: If the insured person goes to an in-network facility, they cannot be billed for more than the in-network cost-sharing amount for their services, even if they receive care from an out-of-network provider.
Note: Out-of-network ambulance services are not covered by the No Surprises Act and can still lead to high bills.
Key terms
In-network providers: Facilities and doctors who contract to accept a payment rate with your insurer. In-network care generally costs less than care that is out-of-network. You might still have to meet a deductible before your insurance pays the bill, or you might owe a copayment or coinsurance, depending on the type of service and your health plan.
Out-of-network providers: Providers who do not contract with your insurer and instead charge you separately for their services. Unlike in-network providers, out-of-network providers set their own charges. Your health plan might cover some of the cost but often covers none of the cost of out-of-network services.
Surprise medical bill: An out-of-network medical bill a person receives from an out-of-network provider for emergency services, or for non-emergency care while at an in-network facility.
Frequently Asked Questions
What is a surprise medical bill?
Generally, people enrolled in private insurance are responsible for checking their plan’s network before getting health services to ensure that the medical provider they’ve selected is in-network. In most situations, people who get medical services from an out-of-network provider are responsible for paying the out-of-network medical bills they receive. Most plans pay less for out-of-network care than they would pay for in-network care, and some don’t cover out-of-network bills at all, leaving the enrollee responsible for paying most or all the out-of-network bill.
There are some situations where a person doesn’t get to choose their medical provider and ends up receiving out-of-network care. This can happen in medical emergencies when people are taken to the closest ER. It can also happen when people select an in-network hospital for scheduled care but receive care from an out-of-network doctor they did not get to pick (such as the anesthesiologist). These scenarios are common. An out-of-network medical bill a person receives after getting care from an out-of-network provider they didn’t get to choose is known as a surprise medical bill.
What are the new protections if I don’t have health insurance or choose not to use it?
If you don’t have insurance or choose not to use it, these new rules make sure you get a “good faith estimate” of how much your care will cost, before you get care. They also allow you to file a dispute if you are charged more than $400 above the estimate.
What out-of-network providers and services must follow the new law?
Any health care provider in any emergency department or at the insured person’s in-network facility must follow the new law. A “provider” is defined broadly to include doctors, radiologists, therapists, and others. Services like imaging and lab work, preoperative and postoperative services, telemedicine, and equipment and devices are also covered. “Facilities” are hospitals, hospital outpatient departments, and ambulatory surgery centers. They don’t include other settings, such as urgent care.
What should I do if I receive a surprise medical bill?
The first step is to check with the insurance company to see if the provider made a mistake. The out-of-network provider shouldn’t bill for more than the in-network cost-sharing amount for the service(s) indicated on the Explanation of Benefits (EOB). If there is no EOB it might mean that the provider didn’t contact the insurance company as required.
The second step is to contact the out-of-network provider and ask them to correct the bill. Providers can face fines up to $10,000 per violation for not following the new rules.
If the provider refuses to resolve the issue by correcting the bill, then it might be necessary to file a complaint by calling the No Surprises Help Desk at 1-800-985-3059. The No Surprises Help Desk is also available for people who have questions or want more information about the new rules. Consumers can also file complaints online at www.cms.gov/nosurprises.
A mistake made by a person’s insurance company could also result in a surprise medical bill. If that happens, the person should call their insurance company, explain the situation, and ask them to treat the claim as a surprise medical bill. If the insurance company doesn’t correct the issue, the next step is to file an appeal with the insurance company. If this is unsuccessful, the next step is to request an external appeal.
Note: Every EOB a person receives is required to include instructions for how to file an appeal.
What out-of-network providers and services are not covered by the new law?
Services that are scheduled in advance directly with an out-of-network provider are not covered under the new law, and the provider can charge patients the full cost for services.
Are all high medical bills considered surprise bills?
Cost-sharing charges can vary widely across insurance plans, which means that a person could still receive very high medical bills due to their plan’s standard in-network cost-sharing charges being high. These kinds of bills are not considered surprise medical bills.
More Resources:
No Surprises Act, Centers for Medicare and Medicaid Services (CMS)
New Extended Coverage for Postpartum Medicaid Beneficiaries
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An important change is here for pregnant and postpartum Medicaid beneficiaries. A provision of the American Rescue Plan gave states the option to extend Medicaid postpartum coverage from 60 days to 12 months. Extended coverage became effective in North Carolina on April 1, 2022. Individuals enrolled in Medicaid for Pregnant Women will now see their coverage extended for a 12-month period after their pregnancy ends.
Research has found that 1 in 3 pregnancy-related deaths occur 1 week to 1 year after delivery. Furthermore, Black and American Indian/Alaska Native women are about 3 times as likely to die from a pregnancy-related cause as White women. By extending coverage, this needed change stands to improve maternal health and stabilize healthcare coverage for postpartum individuals.
Who is eligible?
As of April 1, 2022, Medicaid for Pregnant Women beneficiaries in North Carolina saw their coverage extended for a 12-month period after the pregnancy ends, regardless of any changes in circumstances or if the pregnancy ends for any reason.
A renewal must be completed at the end of the 12-month postpartum period to determine if beneficiary will be eligible for Medicaid after the postpartum period. If/when Medicaid terminates, individuals may be eligible to enroll in affordable coverage with the Health Insurance Marketplace through a Special Enrollment Period.
Please note, Medicaid eligibility rules have not changed in the state of North Carolina.
What is the postpartum period?
The postpartum period is a full 12-months following the end of pregnancy for any reason. The period begins on the date the pregnancy ends and extends through the end of the month in which the 12-month period ends. For example, if a Medicaid beneficiary gives birth on May 5, 2022, their Medicaid coverage will be extended through May 31, 2023.
How do I enroll?
Individuals may apply for NC Medicaid online at epass.nc.gov, in person or by phone at their local Department of Social Services (DSS) office, or by filling out a paper application and mailing, faxing, or dropping it off at their local DSS office.
Health Insurance Navigators are available to help individuals to learn if they are eligible for Medicaid programs in North Carolina, and to complete a Medicaid application. Visit NCNavigator.net, call 855-733-3711, or 980-256-3782 in Mecklenburg, Cabarrus, or Union counties to schedule a free appointment.
If Medicaid is approved, individuals need to report when the baby is born to their local DSS office. This must be done no matter which Medicaid program/category the beneficiary receives. The case worker will then extend the Medicaid coverage through the postpartum period. A letter will be sent to the beneficiary letting them know of the change and the certification periods.
When does the change start?
The effective date of this policy is April 1, 2022. The extended coverage is currently authorized through March 2027.
What if I have questions or need help?
Health insurance navigators are ready to help! Visit NCNavigator.net, call 855-733-3711, or 980-256-3782 in Mecklenburg, Cabarrus, or Union counties to schedule a free appointment.
Still need health insurance? You may qualify for a Special Enrollment Period!
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What you need to know about Special Enrollment Periods
The Marketplace deadline to enroll in or change health insurance plans ended on January 15, 2022 for most people. You still may qualify for a Special Enrollment Period to enroll in Marketplace coverage if you experience certain life changes. You may also be eligible to enroll for coverage through Medicaid or the Children’s Health Insurance Program all year long.
What life changes may make you eligible for a Special Enrollment Period?
You may qualify if:
You or anyone in your household in the past 60 days:
Got married
Had a baby, adopted a child, or placed a child for foster care
Got divorced or legally separated and lost health insurance
You changed your residence:
Moved to a new home in a new ZIP code or county
Moved to the U.S. from a foreign country or United States territory
If you’re a student and moved to or from the place you attend school
If you’re a seasonal worker and moved to or from the place you both live and work
Moved to or from a shelter or other transitional housing
You lost your health insurance:
You or anyone in your household lost qualifying health coverage in the past 60 days
You or anyone in your household expects to lose coverage in the next 60 days
You lost health insurance since 1/1/2020
Important note: You only have 60 days to enroll in Marketplace coverage after one of these changes has occurred.
What is the new qualification for a Special Enrollment Period?
You may now qualify if your estimated annual household income is at or below 150% Federal Poverty Level (FPL).
If you are an immigrant not eligible for Medicaid due to your immigration status, you may still qualify for this Special Enrollment Period even if your income is below the 100% FPL. Household income limits will vary depending on the number of members of a household.
Who qualifies for the new Special Enrollment Period for low-income people?
To qualify, a person must have an annual projected income that is at or below 150% of the Federal Poverty Line:
Number in Household
Annual Household Income
1
$19,320
2
$26,130
3
$32,940
4
$39,750
5
$46,560
6
$53,370
7
$60,180
8
$66,990
If you are a household of one, and your projected income in 2022 is between $12,880 and $19,320, you may be eligible to enroll in Marketplace now or change plans if you are currently enrolled in a Marketplace plan.
If you are a household of four, and your projected income in 2022 is between $26,500 and $39,750, you may be eligible to enroll in Marketplace now or change plans if you are currently enrolled in a Marketplace plan.
If you are an immigrant not eligible for Medicaid due to your immigration status, and your income is below $19,320 (for a household of one), you may be eligible to enroll in Marketplace now or change plans if you are currently enrolled in a Marketplace plan.
When is the new Special Enrollment Period for low-income people available?
Beginning March 22, consumers are able to enroll through this Special Enrollment Period at HealthCare.gov or cuidadodesalud.gov or by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) for enrollment help.
When does coverage begin for someone using a Special Enrollment Period?
A person who enrolls in Marketplace coverage using a Special Enrollment Period will be covered the first day of the month following plan selection, no matter what day you apply.
Who is eligible for Medicaid or the Children’s Health Insurance Program?
Medicaid: People with low income, including individuals, families and children, pregnant women, older adults, and people with disabilities, may qualify. If eligible, you can apply any time.
Children’s Health Insurance Program (North Carolina Health Choice for North Carolina residents): helps children in households that earn too much money to qualify for Medicaid, but not enough to buy private insurance.
Need help enrolling in a Special Enrollment Period, Medicaid, or the Children’s Health Insurance Program?
Health insurance navigators are ready to help! Visit NCNavigator.net, call 855-733-3711, or 980-256-3782 in Mecklenburg, Cabarrus, or Union counties to schedule a free appointment!
Healthcare.gov Premium Tax Credits and Filing Your 2021 Taxes
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If you currently do not have health insurance, we can help! Click here to learn more and make an appointment with a health insurance navigator today.
Health insurance on Healthcare.gov is affordable for many people because the government subsidizes your monthly premiums based on your income. These subsidies are called Premium Tax Credits. If you receive them each month during the year, they are called Advance Payments of the Premium Tax Credit (APTCs).
If you receive these government subsidies, you need to reconcile these payments on your tax return each year. The IRS requires you to do this to make sure that you received the proper amount of subsidies based on your income.
Use Form 8962 to see how much premium tax credit you qualify for based on your actual year-end income. If your income at the end of the year is higher than you estimated on your Healthcare.gov application, you will need to pay back some of your subsidies. This is because you were given more subsidies than you were qualified for, based on your annual income.
If your income at the end of the year is lower than you estimated on your Healthcare.gov application, you may be eligible for a refund. Use form 8962 to claim the Premium Tax Credit.
How do I know if I received APTCs?
If you enrolled yourself or a family member in a Healthcare.gov plan, you will receive Form 1095-A from the Health Insurance Marketplace. This form will show the months that you were covered by a Healthcare.gov plan and will show the amount of APTC that was paid to your health insurance company on your behalf. The Marketplace also provides this information to the IRS.
Are there changes for filing taxes in 2021? What do I need to do?
Last year the IRS announced individuals didn’t need to repay excess APTCs for tax year 2020. This is not the case for 2021 tax return. If you received excess APTCs in 2021, you will be required to pay these back when you file your tax return.
If you find on Form 8962 that you received a smaller amount of subsidies than you qualify for based on your year-end income, you may claim the Premium Tax Credit on form 8962.
As a reminder, this change applies only to tax year 2020. The deadline to file your 2021 federal income tax return is April 18, 2022. If you do not reconcile your APTCs by filing your 1095-A on your 2021 tax return, you run the risk of not being eligible for APTC in future years.
Open Enrollment for the Health Insurance Marketplace (AKA Healthcare.gov) will open Nov. 1, 2021, and last until Jan. 15, 2022.
Our federally trained Navigators answer your top health care coverage questions and share important information on where to find help during this year’s Open Enrollment. Siga el enlace para videos en español.
Frequently Asked Questions
Let’s go over some Open Enrollment vocabulary: ACA, Obamacare, Healthcare.gov, Marketplace
What are the benefits of health care coverage from the Marketplace?
Who qualifies for health care coverage, how do you apply, & why do you need to re-enroll?
What programs are available to help people pay for health care?
What is the Medicaid gap or coverage gap? What are some resources for people in the Medicaid gap?
What are the rules on health care coverage for immigrants?
Where can I get help learning about health care coverage and how to enroll?
Preguntas frecuentes en español
Revisemos algunos conceptos importantes sobre el período de inscripción abierta: ACA, Obamacare, Mercado de seguros y www.cuidadodesalud.gov
¿Cuáles son los beneficios de obtener Seguro de salud en el Mercado de Salud?
¿Quiénes califican para Seguro médico, cómo aplicar y por qué necesita reinscribirse?
¿Qué programas de asistencia financiera están disponibles para asistencia de Seguro médico?
¿Qué es el gap de cobertura de Medicaid?¿Cuáles son las opciones para las personas en el gap de cobertura de Medicaid?
¿Cuáles son las reglas para que los inmigrantes puedan acceder a Seguro de salud?
¿Dónde puedo encontrar más ayuda disponible sobre temas de Seguro de salud?
Basic Health Insurance Terms
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Need to enroll in a health insurance policy or update the one you have?
Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) is Nov. 1, 2022, to Jan. 15, 2023.
There are a lot of special terms in the health insurance world, and they can be difficult to understand. We’re here to help you make sense of terms you see on Healthcare.gov.
Watch the video and scroll down for more terms defined.
Learn more about how to get covered, or call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.
Catastrophic Health Plan The premium amount you pay each month for healthcare is generally lower than for other plans, but the out-of-pocket costs for deductibles, copayments and coinsurance (see terms defined below) are generally higher. To qualify for a Catastrophic plan, you must be under 30 years old OR get a “hardship exemption” or “affordability exemption” (the Marketplace determines that you are unable to afford health coverage because of the cost of the health insurance plan offered to you is too expensive or you have a financial hardship circumstance).
COBRA A federal law that may allow you to temporarily keep health coverage after your employment ends. If you choose COBRA coverage, you pay 100% of the premiums, including the portion that your employer used to pay, plus a small administrative fee.
Coinsurance Like a copayment (see next term), but in the form of a percentage of the cost of a healthcare service (e.g. you pay 20% of the cost of a visit or procedure).
Copayment A set amount that you pay for a medical service or item, like a doctor’s visit. The insurance company covers the rest.
Deductible The amount you have to pay for covered health care services (e.g. doctor and hospital visits, labs, etc.) before your health insurance or plan begins to pay. Often, the health insurance company will only pay a percentage of the costs after you reach your deductible. If you think you will need a lot of healthcare services in a year, you should look for plans with a low deductible.
Metal Categories of Health Plans In addition to catastrophic plans, Healthcare.gov plans come in four metal categories: Bronze, Silver, Gold and Platinum. Bronze plans are usually best for individuals who have few health needs but want to be prepared in case of an emergency. Bronze plans have the lowest monthly premiums, but they have a high deductible. Gold and Platinum plans are often best for people who use a lot of health services. They have the highest monthly premiums, but each visit to the doctor and each prescription will have a low copay/coinsurance. Plans in all metal categories provide free preventive care (for example, a yearly wellness visit to your doctor).
Silver plans are ideal for individuals/families with income less than 250% FPL. If you select a Silver plan, you will receive cost sharing reductions, which means your out of pocket costs (deductible, coinsurance and copays) are also subsidized and may be very low.
Network The doctors, hospitals and suppliers your health insurer has contracted with to deliver health care services to their members. Ask a healthcare provider if they accept your insurance before you visit. If you go out of network, your care will be more expensive.
Out-of-pocket Maximum Usually a larger number than your deductible. This is the absolute maximum amount of money you will have to spend in the year on healthcare costs. After you reach this amount, the health insurance company will cover all services 100%.
Plans and Prices Tool: https://www.healthcare.gov/see-plans/#/ Saves you time! This tool allows you to see what plans are available in your area and how much financial assistance you qualify for before you fill out an application.
Pre-existing Conditions A health problem, like asthma, diabetes, or cancer, that you had before the date that new health coverage starts. Insurance companies can’t refuse to cover treatment for your pre-existing condition or charge you more.
Premium The amount you pay for your plan each month.
Premium Tax Credit The “subsidies” that lower the cost of your monthly premiums. You can take the premium tax credits in advance to lower your monthly cost, or you can take them as a refund at tax time.
Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During this Open Enrollment Period, navigators have received calls and questions from Cabarrus, Mecklenburg and Union County residents about the household income section of the Healthcare.gov application. With this year’s pandemic and economic uncertainty, many have lost or changed employment and are struggling to estimate their income.
Listed below this video are some helpful tips and general guidelines. More of what to (and not to) include is available at charlottelegaladvocacy.org/getcovered.
Important points:
You must estimate your projected income for the upcoming year.
If you are unemployed, it may be difficult to do this. Estimate how much you would make if you returned to your previous job.
If you don’t have a set salary or wages (for example, if you are a freelance worker, seasonal worker, or run your own business), it will be easier to estimate your income if you have a copy of your tax return from last year on hand.
If you are self-employed, you should input your net income. Click here for more help estimating your self-employment income.
If your income is very low or if you are unemployed, and you or a family member falls into one of the following groups, you may qualify to receive Medicaid:
children under 21
pregnant women
women with breast or cervical cancer
primary caretaker of a child under 18
individual in foster care when turned 18
individuals aged 65 or older
blind or disabled individuals
people in need of long-term care
people receiving Medicare
You must report changes in income.
During the year, you must go back into your application to report if your income goes up or down. This will keep your monthly premium at a manageable price and help to reduce the amount of financial assistance you may have to pay back, if any at all.
You can receive financial assistance.
Estimating your income as accurately as possible allows the Marketplace to determine your eligibility for financial assistance.
Be sure to include:
Anticipated changes in income
Consider these questions: How might your income change in the coming year? Are you expecting business to improve or worsen? Will you be getting a raise? Work more hours? Get a seasonal job? Will another household member get a job? Will you gain or lose a dependent?
The anticipated income of all household members
If another person in your tax household has health coverage through a different plan or program, you still need to include their income on your application. Marketplace financial assistance is based on the income of all tax household members. You will be able to clarify on the application which household members do not need health coverage. Tax household members not applying for coverage are not required to provide any other information except income information (e.g. They do not have to provide a Social Security Number).
Some disability-related income
Only include Social Security disability payments when estimating your income for next year. Do not include Supplemental Security Income, only Social Security retirement or disability payments.
Income from investments
Things like stocks and bonds.
Alimony
Include only if your divorce or separation was finalized before January 1, 2019.
Do NOT include:
Self-employment expenses
Subtract any self-employment expenses from your estimated income.
Some disability-related income
Do not include Veterans’ disability income payments, Supplemental Security Income (SSI) payments, and workers’ compensation payments when estimating your income for next year.
Social Security payments for applications that have not yet be approved
You can update your Marketplace application later next year if your application is approved.
Alimony
Do not include if your divorce or separation was finalized on or after January 1, 2019.
Child support
Free appointments with a local navigator can be made using the statewide appointment hotline at 1-855-733-3711, or online at www.ncnavigator.net. Appointments are filling quickly!
Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During the Open Enrollment Period, navigators take appointments free of charge with residents of Cabarrus, Mecklenburg and Union County who are concerned about making common errors that could jeopardize their ability to maximize coverage and minimize cost.
Find FAQs and how to make an appointment and keep reading to learn the top four mistakes navigators see people make on the Health Insurance Marketplace.
1. Missing the Deadline
The Open Enrollment Period is going on now through Jan. 15, 2022. It is very difficult to qualify to sign up for health insurance on the Marketplace beyond the designated timeframe. Usually, adjustments or new enrollments are allowed only as a result of a major life event, such as marriage, divorce, job loss or a new child.
2. Misunderstanding Costs
During Open Enrollment, some people only look at the cost of premiums and don’t take into consideration the deductibles, copays, coinsurance and out-of-pocket maximums. These are all important factors that will help determine your overall health care costs in 2022.
3. Over- or Under-Insuring
A basic high-deductible plan generally has the lowest monthly premium, but it requires the policy holder to spend more before full coverage kicks in. Some people mistakenly select this option because they think it will be cheapest, but they ultimately pay more out of pocket. Navigators suggest a quick assessment of your health care spending over the last couple of years. If you tend to undershoot your deductible, you might be better off moving to a high-deductible plan. If you usually hit your deductible before it resets, you could come out ahead by paying a higher premium for a heartier plan. Remember: The cost of many preventive measures, such as mammograms, colonoscopies and cholesterol screenings, are covered 100% before you meet your deductible and require no copay.
4. Opting Out
A few years ago, not buying health insurance meant facing a potentially costly penalty. While that penalty no longer exists, forgoing coverage is a big mistake. A single illness or injury could total thousands of dollars out of pocket.
You took the step to enroll for health insurance coverage using Healthcare.gov. Congratulations! You’ve joined more than 31 million people who have the peace of mind of knowing they are covered with access to preventive health care and life-saving screenings.
Take advantage of free services.
Preventive health services are included in every Healthcare.gov plan and are free. They are routine health care procedures such as screenings, check-ups, and counseling to prevent illness and other health problems.
All Healthcare.gov plans are required to cover preventive health services 100%. This means that insurance companies cannot charge you a copay or coinsurance to get this type of medical attention. For example, an annual check-up, immunizations, children’s vision screenings, contraception and well-woman visits are free. You’ll just need to show your health insurance card at your doctor’s office. Get specific lists of preventive services for adults, women and children.
Preventive services are free only when you get them from a doctor or other provider in your plan’s network. (A network is the facilities, providers and suppliers your health insurance company has contracted with to provide health care services.) Talk to your doctor about taking advantage of these free services to keep you and your family healthy.
Look at the Summary of Benefits and Coverage.
To understand your plan better, and to be prepared in case of illness or an emergency, read the Summary of Benefits and Coverage that comes with your plan. Log in to your Healthcare.gov account or call your health insurance company to get a copy.
This document will give you a snapshot of your possible costs throughout the year and includes examples of common medical events. For example, it will explain how much a hospital visit or prescription drugs will cost you.
Know where to go for care.
You can get health care at many different places, including the emergency department when you’re injured or very sick. But it’s best to get regular care from a primary care provider (often a doctor at a family medicine clinic). Primary care providers work with you to make sure that you get the right services, manage your chronic conditions and improve your health and well-being. It might take more than one visit to figure out if a provider is right for you, so it’s important to be proactive and start your search now.
If you aren’t sure how to find a doctor in your area, your health insurance company’s website is a good place to start. If you have a health insurance plan in the Charlotte area, use the following provider search tools:
Or, if you know of a doctor that a friend or family member recommended to you, you can call that doctor’s office to see if they accept your health insurance plan. Remember, your care will be a lot cheaper if you go to a doctor in your health plan’s network.
Check out this guide for more great tips on how to make your health insurance work for you.
If you have questions about your coverage, or your income or health care needs change at anytime, call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.
