Your unique needs
Written by Katie Carpenter
Dec 9, 2013 11:09 AM
We'll highlight some specific areas where your demographic and circumstances will predispose you to certain options in the FAQ's, resources and tips below.
I have a pre-existing condition
Insurers are no longer able to deny adults coverage or charge them higher premiums because of pre-existing conditions. 5,489,162 Pennsylvanians under age 65 have a pre-existing health condition that, before the new law, put them at risk of being denied coverage or gouged on rates. Who's Eligible for PCIP? PCIP coverage is for people with a pre-existing medical condition who’ve been without health coverage for at least 6 months, no matter what your income is. See full eligibility requirements.
All Health Insurance Marketplace plans cover pregnancy and childbirth. All Marketplace health plans and many other plans must cover this list of preventive services for women without charging you a copayment or coinsurance (with an in-network provider): Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women; Folic Acid supplements for women who may become pregnant; Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk; Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users; Urinary tract or other infection screening for pregnant women
I'm an immigrant
What if I am an immigrant in the U.S. legally? Legal immigrants are permitted to use the marketplaces — and may qualify for subsidies if their income is less than about $46,000 for an individual and $94,200 for a family of four. Legal immigrants may qualify for Medicaid if their income is low enough. The laws governing benefits to lawful immigrants are quite complex. The federal Department of Health and Human Services has a guide to Medicaid and other benefits for immigrants. What if I am an undocumented immigrant? Immigrants who are in the country illegally are barred from buying insurance on the exchanges.
I'm interested in Medicaid
You can see if you qualify for Medicaid by completing an application at HealthCare.gov
I'm an early retiree
Too often, Americans who retire without an employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. For more information on the Early Retiree Reinsurance Program, visit www.ERRP.gov
If you run an income-generating business with no employees, then you're considered self-employed (not an employer) and can get coverage through the Marketplace. You’re not considered an employer even if you hire independent contractors to do some work. If you have employees (generally, workers whose income you report on a W-2 at the end of the year) you’re considered an employer.
I have HIV/AIDS
About one in four people with HIV in care in the U.S. are currently uninsured and many more are underinsured. This new portal, Greater Than AIDS, helps people living with HIV navigate their insurance options under the Affordable Care Act.
I'm a cancer patient
Pre-existing conditions:Individuals cannot be denied coverage for insuance. This will allow cancer patients to have portability of coverage. Many cancer patients feel locked in to insurance and might even feel locked into an employer as they don't want to risk losing their insurance; Abolition of lifetime caps:There are more and more survivors of cancer, and many of those survivors wish to remain in touch with their doctor as they may need lifetime surveillance of their disease; Preventive screenings:The law will also increase access to and coverage for preventive screenings like mammograms and colonoscopies.
We're a military family
If you are a service member, retiree, family member, or survivor covered by TRICARE, you have MEC. There is no need to purchase additional health insurance. If you are using any of the following health plan options, you have the coverage required by the Affordable Care Act: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, TRICARE Standard and Extra, TRICARE Standard Overseas, TRICARE For Life, US FamilyHealth Plan, Martin’s Point Health Care, Brighton Marine Health Center, Saint Vincent Catholic Medical Centers of New York, Johns Hopkins Medicine, Christus Health (source- National Military Family Association)