A Louisiana Healthcare Navigator will provide you with the accurate and up-to-date information regarding eligibility, enrollment, and Affordable Care Act specifications with information about enrollment in Qualified Health Plans (QHPs) and other health programs such as Medicaid and LaCHIP to the people in Louisiana.

You are eligible to enter the Health Insurance Marketplace if you meet the following requirements.

• U.S. Citizen or legally in U.S. during entire coverage period.
• Live in the insurance companies’ service area.
• Individuals with income below 400% of Federal Poverty Level.
• Offered coverage at work but it is not affordable and/or at least 60% actual value

There will be four basic levels of coverage: Platinum, Gold, Silver and Bronze. This ranking system will make it easy to compare different health plans. As the metal category increases in value, so does the percent of medical expenses that a health plan will cover. These expenses are usually incurred at the time of health care services—when you visit the doctor or the emergency room, for example. The health plans that cover more of your medical expenses usually have a higher monthly payment but you will pay less whenever you receive medical care.

You can choose to pay a higher monthly cost so that when you need medical care, you pay less. Or you can choose to pay a lower monthly cost so that when you need medical care, you pay more. You can choose the level of coverage that best meets your health needs and budget.
For more information about the basic levels of coverage, visit here.

Open enrollment in 2019 for Marketplace insurance has not yet been announced. You may apply and become eligible for coverage outside of the Open Enrollment period if you meet certain special eligibility requirements.

You may qualify for a Special Enrollment Period (SEP) if you or anyone in your household in the past 60 days experiences:

Changes in household size

• Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
• Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
• Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
• Died. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

Changes in residence

Household moves that qualify you for a Special Enrollment Period:

• Moving to a new home in a new ZIP code or county
• Moving to the U.S. from a foreign country or United States territory
• If you’re a student, moving to or from the place you attend school
• If you’re a seasonal worker, moving to or from the place you both live and work

Moving to or from a shelter or other transitional housing

Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.

Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

Loss of health coverage

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.

• Coverage losses that may qualify you for a Special Enrollment Period:
• Losing job-based coverage
• Losing individual health coverage for a plan or policy bought yourself
• Losing eligibility for Medicaid or CHIP
• Losing eligibility for Medicare
• Losing coverage through a family member

More qualifying changes

Other life circumstances that may qualify you for a Special Enrollment Period:

• Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
• Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
• Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
• Leaving incarceration
• Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

The Marketplace is a way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.

With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll.

Visit healthcare.gov for more info.

In all states, there will be people trained and certified to help you understand your health coverage options and enroll in a plan. In Louisiana they are known as the Louisiana Healthcare Navigators. Visit our Contact Us section here on this website to get contact information for a Navigator in your area.  You can also fill out the Request Enrollment Assistance form and a Health Insurance Navigator will contact you to set up an appointment.

If you have job-based health insurance you like, you can keep it.  You may be able to change to Marketplace coverage if you want to.

If your health care premium is more than 9.5% of your gross income, you may choose what your employer offers or shop for insurance through the marketplace.

When you use the Health Insurance Marketplace you may be able to get lower costs on monthly premiums or out-of-pocket costs, or get free or low-cost coverage.

You can save money in the Health Insurance Marketplace 3 ways. All of them depend on your income and family size.

• You may be able to lower costs on your monthly premiums when you enroll in a private health insurance plan. These plans all cover essential health benefits and pre-existing conditions.
• You may qualify for lower out-of-pocket costs for co-payments, co-insurance, and deductibles.
• You or your child may get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program CHIP.
• Some states will be expanding Medicaid eligibility, so you may qualify even if you have been turned down for Medicaid in the past.

In addition to comparing multiple health insurance plans offered by different private health insurance companies, consumers who complete and submit an application through the Health Insurance Marketplace will find out whether or not they qualify for financial assistance to help pay for health insurance premiums and out-of-pocket costs.

You can apply for Marketplace health coverage online at www.healthcare.gov, by phone at 1-800-318-2596, with a paper application, or with the help of a trained associate in your community.

That depends on how you submitted your application. If you completed a paper application you will need to wait for the Marketplace to contact you with your eligibility determination in order to find out whether or not you are eligible to enroll in health insurance through the Marketplace and whether or not you qualify for financial assistance to help pay for health insurance premiums and out-of-pocket costs.

If you completed an application over the phone or through the Marketplace website, www.healthcare.gov, you should know the results of your eligibility determination instantly.

Regardless, once you know the results of your eligibility determination you are ready to compare prices for different health insurance plans in order to find out which one best meets your needs.

You can file an appeal and have your issue revisited.

You can appeal the following kinds of Marketplace decisions:

• Whether you’re eligible to buy a Marketplace plan
• Whether you can enroll in a Marketplace plan outside the regular open enrollment period
• Whether you’re eligible for lower costs based on your income
• The amount of savings you’re eligible for
• Whether you’re eligible for Medicaid or the Louisiana Children’s Health Insurance Program (LaCHIP)
• Whether you are eligible for an exemption from the individual responsibility requirement

https://www.healthcare.gov/marketplace-appeals/appeal-forms/ 

You still need to keep up with any life changes that may affect your eligibility for health insurance or financial assistance. Report any changes in expected household income or household size to the Health Insurance Marketplace as soon as possible in order to ensure that information about your current Marketplace eligibility and financial assistance is up to date.

Consumers who qualify for financial assistance through the Health Insurance Marketplace will receive Advance Premium Tax Credits to help pay for health insurance purchased through the Marketplace. You will need to provide information about your tax credit when you file your Federal Income Tax Return.

The Marketplace will provide you with form 1095-A if you purchased health insurance through the Individual Marketplace for yourself or your family. This form will detail the amount tax credit you received for the applicable tax year. It will also serve as your proof of coverage for year.

If you only had health coverage for a portion of the year, that information will be reflected on the form 1095-A and you may be subject to a penalty for the months that you did not have coverage (read more about penalties here). Be sure to check your email and/or traditional mail for your 1095-A and never throw away information sent from the Health Insurance Marketplace.

You should receive a notification from the Health Insurance Marketplace detailing your eligibility for insurance and/or financial assistance after completing and submitting an application. You will either receive notification through traditional mail or via e-mail (depending on which notification method you chose when submitting your application to the Marketplace). If you do not receive an eligibility determination you should contact the Marketplace by phone or by logging into your Marketplace account on www.healthcare.gov to check the status of your application and to ensure that your contact information is up-to-date.

If you did not have health coverage at all in 2018, you may be subject to a penalty when you reconcile your Federal Income Tax Return. To find this year’s fee, click here.

If you only had coverage for part of 2018, your penalty will be prorated for the months that you did not have coverage. You will not pay a penalty for months that you had health coverage. You are considered covered in a given month if you had health coverage for at least one day in that month.
Some individuals will be exempt from the penalty. Exemptions can be found here.

Beginning in tax year 2019, there will be no tax penalty for not having health insurance coverage.

You should contact your local Federally Qualified Health Center. Federally Qualified Health Centers provide low-cost primary care to under-served rural and urban communities. They can help you meet your basic primary care needs in addition to providing referral and eligibility information for State and Federal assistance programs that you may qualify for. You can find a list of FQHCs here.