The Marketplace for the Affordable Care Act is now open! Make sure to look through our new FAQ section on it below.
- Questions about the Affordable Care Act?
- I need health insurance or other care
- I have TennCare, but I can’t get the care I need. How do I appeal?
- I know a foster child that needs help
- I am a teacher, school social worker, or school staff and know a child who needs health insurance
- Necesito ayuda en español
- Other resources
Questions About the Affordable Care Act?
Q. What is the Marketplace?
A. The Marketplace is a new way to buy health insurance for 2014. In fact, it is the only place where you can apply for insurance and get financial help. The Marketplace is an online store where you will be able to shop, qualify for, and buy new health insurance programs. You can find the Marketplace at www.healthcare.gov or call 1-800-318-2596.
Q. Where can I apply for Marketplace coverage?
A. Go to www.healthcare.gov or call 1-800-318-2596 to enroll in the Marketplace. You can go online or call seven days a week, 24 hours a day.
Q. How do I apply for Marketplace coverage?
A. First, you will need to set up an account. You will need to provide basic information about your income, household size, and current health coverage.
Next, you will choose a username, password, and security questions. Use this username and password every time you go to the Marketplace.
Q: What information do I need to know to apply?
A. You will be asked to provide basic information about yourself and/or your family. You will need the following:
- Your social security number
- Documentation if you are a legal immigrant
- Income information: W-2 Forms from last year and pay stubs or payroll information
- Employer’s name and address
- Policy numbers for any current health insurance
The information you provide about your income is very important. It determines how much financial assistance you receive each month. The lower your income the higher the financial help you will receive each month. In addition, it is important that you accurately estimate your 2014 income for tax reasons. At the end of 2014, the IRS is going to compare the number you provide with the income you report on your 2014 income tax return.
Q. When can I apply for health insurance on the Marketplace?
A. The Marketplace opens October 1, 2013 for coverage starting January 1. You will be able to get a health plan on the Marketplace until March 31, 2014. After that, you may have to wait until October 2014. You may be able to get a plan if you lose your job, or there are significant changes such as a birth, divorce, or death.
Q: When will the coverage begin?
A. If you buy a health insurance plan on or before December 15, 2013, then coverage may begin on January 1, 2014.
Q. Can I be denied health insurance?
A. No, you can’t be denied coverage. Starting in 2014, insurance companies can’t turn you down or charge you more because of a pre-existing condition or other health status.
Q. Do I have to buy health insurance?
A. Yes, you’re required by law to buy health insurance for 2014. If you don’t, you might have to pay a penalty.
There are some people who do not have to buy health insurance. These exempted groups include:
- People with low incomes who do not file tax returns. To find out if you are required to file a federal tax return, use the IRS Interactive Tax Assistant (ITA).
- Certain religious groups
- Incarcerated people
- Someone who lives outside US for 11 months out of the year
- Undocumented residents
- People who go without coverage for less than 3 months
- People who do not have an affordable offer of coverage. This means that if your monthly premium for your only offer of coverage is more than 8% of your monthly household income, the coverage is not affordable.
Q. What if I already have health insurance?
A. People who have health coverage through private insurance, from an employer, TennCare, or Medicare don’t have to buy on the Marketplace.
Q. What if I don’t like the insurance that my employer provides?
A. You can buy a more preferable plan on the Marketplace. However, you might not qualify for financial assistance paying your premiums and other health care costs. If your employer’s offer of coverage is considered “affordable” and meets “minimum value,” then you will not be able to get financial help. Your employer is supposed to give you tell you if the insurance at work is “affordable” and meets “minimum value.”
Q. How can I receive financial help to pay my monthly premium?
A. The available financial help depends on income levels. The financial help is called premium tax credits.
Q. What are premium tax credits?
A. Premium tax credits lower your monthly insurance premiums. Persons and families between 100%-400% of poverty line may be eligible for help with paying for health insurance. For example, if you are a family of four with income below $94,200, you may be eligible for credits that will lower your monthly costs. If you’re eligible, the government will pay a portion of your monthly premium directly to the insurance company. You will pay the remainder of what the government does not pay. Premium tax credits stay the same no matter which healthcare plan you choose. See what tax credits you would be eligible for using the Kaiser calculator here.
Q. How can I find out if I will get premium tax credits?
A. When you enroll for insurance at the Marketplace, you will be asked about your income and then you will be told the amount, if any, of the premium assistance that will be paid to the insurance company.
Q. What are the basic health insurance plans?
A. There are 4 basic plans: platinum, gold, silver, and bronze. The plans will include the same essential benefits. The amount consumers pay for deductibles, co-payments, and other services will differ between the plans.
Q. What benefits do the Marketplace insurance policies cover?
A. All insurance sold on the Marketplace must include 10 essential health benefits:
- Maternity & Newborn care
- Rehabilitative & Habilitative Care
- Pediatric Services
- Mental Health & Substance Use Disorder Service (Behavior Health Treatment included)
- Preventative & Wellness Services & Chronic Disease Management
- Laboratory Services
- Prescription Drugs
- Ambulatory Patient Services
- Emergency Services.
Q. Can I choose my own doctor?
A. Most health insurance plans have networks of hospitals, doctors, specialists, pharmacies, and other health care providers. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing plans in the Marketplace, you will see a link to a list of providers in each plan’s network. If staying with your current doctors is important to you, check to see if they are included before choosing a plan.
Q. Can I get dental insurance?
A. Dental insurance is different for adults than it is for children under 18.
For adults, dental is not considered an essential health benefit. This means insurers do not have to offer dental care to adults. Some plans offer dental insurance and some do not. If you want dental coverage, you can buy a separate plan for dental.
For children, dental coverage is an essential health benefit. This means insurers have to offer dental care to children 18 and under as part of the health plan or as a stand-alone plan. Read your health plan carefully to make sure you know what is included.
To read more, click this link.
Q. What happens if I do not pay my premium?
A. If you miss several payments, the insurance company will send you a notice of cancelation. You have the chance to appeal the notice. If you do not appeal or pay your fees, the insurance company can cancel your insurance coverage 30 days after notice is distributed.
Q. How do I pay on the marketplace?
A. You can pay by personal check or cashier’s checks, money orders, pre-paid debit cards, electronic fund transfers from a bank account, and an automatic deduction from a debit/credit card. You cannot pay with cash.
Note: Your enrollment is not complete and your coverage is not effective until the insurance company receives your first premium payment.
Q. How do I protect myself from frauds and scams?
A. Never give out your social security number, bank account number, or email address to anyone over the phone unless you made the call. If someone calls you asking for your personal information, do not give him any information. Ask for a number to call back. If you receive an email from someone claiming to need your personal information, do not respond.
Also, there are fake enrollment sites. Remember that the only place Tennesseans can buy the new insurance AND get tax credits is at the Marketplace, www.healthcare.gov.
Q. What do I have to do if I have Medicare?
A. If you already have Medicare, you do not need to do anything. Your Medicare will stay the same, with a few beneficial changes: there will be more preventative care services provided, and the donut hole—a gap in coverage where there is a temporary limit on what the plan will pay for drugs—will be closed.
Versión en español: “Inmigrantes y la Ley Cuidado de Salud a Bajo Precio (ACA)”
Need Health Insurance or Medical Care?
Q: What TennCare services can my child get?
A: Kids on TennCare have a right to all the health care they need. There’s a law that says so! These services include mental health services, physical therapy, speech therapy, medical equipment, home health care, dental care, vision care, and much more! Learn more about TennCare provides for children.
Q: How do I apply for TennCare?
A: Starting January 1st, you can now apply for TennCare at healthcare.gov, or call them at 1-800-318-2596. Be sure to check out FAQs above for information on how to get onto the website, and what information you’ll need.
If you have questions about TennCare, you need to report any changes to your address, income or household, or you want to apply to CHOICES, call the Tennessee Health Connection at 1-855-259-0701.
Q: What groups does TennCare currently cover?
A: TennCare has multiple different eligibility categories for families, children, and individual adults. Almost all of them have strict requirements on income and resources. If you’re not sure whether you’re eligible, you can always apply. For an overview of which groups TennCare covers, download this flyer (PDF).
Note: Teens with health insurance do better in school, miss fewer days of school and are much less likely to have unmet health needs, however, teens are the largest group of children who are eligible for public health insurance but are uninsured.
Q: What is Spend Down?
A: Spend Down is a category of eligibility for TennCare. Most categories have very strict requirements on how much income a family can have. Spend Down lets a family use medical bills and expenses to offset that income. Spend Down is currently open to all children and is called Medically Needy Spend Down. There are occasional windows when adults can apply for themselves, too. This is called Standard Spend Down.
The rules about counting bills and income are very complicated, click here to download our Medically Needy Spend Down flyer and worksheet. The worksheet can also be used for counting bills for Standard Spend Down.
Q: My child can’t get TennCare. Can CoverKids help?
A: CoverKids can help some children who do not qualify for TennCare. The child cannot have other insurance, either. CoverKids is a public health insurance program. Learn more about CoverKids.
Q: What if it’s a medical emergency, and I can’t pay?
A: You still have a legal right to get hospital care for an emergency or childbirth. They can’t turn you away until a doctor has examined you. An emergency room card can help you get care. Find out more about how to get emergency room care.
Q: Will TennCare pay for nursing home care? What about nurses I need at home?
A: TennCare provides important financial protections for nursing home eligible patients and their families. If you are nursing home eligible, TennCare will either pay for you to get care in a nursing home, or they will pay for nurses and aides to come to your house if it is cheaper. Find out more about how to apply for nursing home coverage and in-home coverage.
Q: Can I get help paying my Medicare premium?
A: There are Medicare Premium Assistance Programs that pay Medicare premiums for some people. One of the plans, sometimes called QMB, pays the Medicare Part B premium and also pays the portion of medical costs that Medicare does not pay. The other plans, SLMB and QI, only pay the Medicare Part B premium. Apply for QMB. The state will check to see if you can get on any of these plans. Find out more about how to apply for QMB.
Q: Can I get help paying for medicine?
A: Whether you are insured or not, you might have trouble getting the medicine you need. Here are some tips on how to get low or no-cost medicines.
Q: What is the Pickle Amendment?
A: The Pickle Amendment gives eligibility to some people who now get Social Security Disability payments (SSDI) but who used to get SSI. If you were ever eligible for SSI and SSDI in the same month, you might be eligible for benefits. Learn more about Pickle Eligibility.
Q: I am an immigrant. Can I get health care for me and my family?
Many low-income, legal immigrants or their family members may be able to get TennCare. There are also other options. Read more about the questions that immigrants and their families often ask about health care in Tennessee. For this same document en Español, read here.
TennCare Won’t Pay for the Care I Need. How Do I Appeal?
Q: What are my child’s TennCare service appeal rights?
A: Kids on TennCare have a right to all the health care they need. Learn what to do if TennCare won’t give your child the care they need.
Q: How do I appeal?
A: Do you have a problem with TennCare, Families First or Food Stamps? An appeal might fix the problem. There are two kinds of appeals – eligibility and services. There are different rules for these appeals. Find out more about appealing.
Q: I have an upcoming TennCare hearing. What are my rights and what should I expect?
Q: I’m on TennCare, so why am I getting bills?
A: Some of these bills might be mistakes! TennCare may need to pay them. Read more about getting bills while on TennCare.
Foster Parents and Children
Q: Can I stay on TennCare after I leave DCS custody?
A: Yes! Because of the Affordable Care Act, foster children who got out of foster care when they turned 18 or decided to stay in foster care after turning 18 can get TennCare until they are 26! See more information here.
Q: How can I get TennCare services for a child in foster care?
A: A law called EPSDT promises all necessary medical and mental health services for children in, or at risk of entering, State Custody. If a child in foster care isn’t getting the health care they need, you can tell the juvenile court and file an appeal. Find out more about how to get services for children in custody.
Q: When can I appeal for a child in foster care?
A: If you know a child in state custody who is not getting the physical or mental health care they need, you can file an appeal. Birth parents, foster parents, Guardians ad litem, CASA volunteers, doctors, and advocates can all file appeals. Find out more about when you can appeal for a child in foster care.
Q: I am a teacher, school social worker, or school staff and have found that some of our students don’t have health insurance. What can I do?
Q: ¿Qué servicios para niños provee TennCare?
A: Su niño tiene derecho a recibir el cuidado médico que necesita. Puede recibir servicios como terapia física o del habla, equipo medico, y cuidado dental. Aprenda más sobre TennCare.
Q: ¿Tengo derecho de apelar si TennCare niegue algo?
A: ¡Sí! Su niño tiene derecho a recibir el cuidado médico que necesita. Si TennCare niegue algo, puede apelar. Aprenda más sobre el proceso de apelar.
Q: Mi hijo no puede obtener TennCare. ¿Puede recibir CoverKids?
A: CoverKids puede ayudar a unos niños que no califican para TennCare. El niño no puede tener otro seguro médico. CoverKids es un programa pública – entonces un niño debe tener papeles para recibirlo. Aprenda más sobre CoverKids.
Other Links & Resources
Q: I didn’t see my question here. Where else can I look for help?
A: If you didn’t find the answer to your question, try checking the flyers at Legal Aid’s website. Legal Aid helps with lots of issues besides health care. They have information on renters’ rights, filing your taxes, dealing with paycheck garnishment, and many other questions. If you have a specific question about TennCare, call the TJC to find out if we can help you.