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ACA/Marketplace Plan

Medicaid & CHIP

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Shop high-quality insurance plans from different carriers, all in one place with us. Apply now to explore options and lower your overall health insurance costs.

Medicaid & CHIP coverage

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to low-income individuals, families, children, pregnant women, seniors, and people with disabilities. Some states may expand Medicaid to cover all individuals under 65 with incomes below certain levels.

ACA/Marketplace Plan

If you are not eligible for state Medicaid, the American Rescue Plan Act of 2021 may help you save on Marketplace health insurance coverage. If your expected annual income is between 100% and 400% of the federal poverty level (FPL), you may qualify for a Marketplace plan with advance premium tax credit (APTC) payments.

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Frequently Asked Questions

Medicaid is a public government health insurance program for low-income families and
individuals regardless of their age.

Medicare is a public government health insurance program for 65 years and older.

Marketplace is where everyone can shop for health insurance in the United States & apply for assistance that could lower the cost of your health coverage.

An open enrollment period is a window of time that happens once a year typically from November 1 to Dec 15 in most states when you can sign up for health insurance, change your current plan or cancel your plan. Some states can have longer open enrollment periods.

If you are currently eligible for Medicaid, Medicaid will ask you to provide any change such as your address, phone number, income or other information yearly to redetermine the eligibility for the upcoming year.

There is absolutely no service fee and all services are free of charge.

Frequently Asked Questions

Health insurance is a contract between you and an insurance company that helps pay for medical expenses. You typically pay a monthly premium, and when you receive covered healthcare services, the insurer pays part of the cost according to your plan's rules. You may still be responsible for deductibles, copays, coinsurance, and services that are not covered.
Premium: The amount you pay regularly (usually monthly) to keep your insurance coverage active. Deductible: The amount you must pay for covered healthcare services before your insurance starts sharing costs. Copay (Copayment): A fixed amount you pay for a specific service, such as $25 for a doctor's visit. Coinsurance: Your share of the cost after you've met your deductible, usually expressed as a percentage (for example, you pay 20% and the insurer pays 80%).
The out-of-pocket maximum is the most you will pay for covered healthcare services during a plan year. Once you reach this limit through deductibles, copays, and coinsurance, your insurance generally pays 100% of covered in-network services for the rest of the year. Premiums usually do not count toward the out-of-pocket maximum.
Coverage varies by plan, but common covered services include: - Doctor visits - Hospital care - Emergency services - Laboratory tests - Mental health services - Maternity care - Prescription drugs - Preventive care Review your plan's Summary of Benefits and Coverage (SBC) or member handbook for specific details.
In-network providers: Have contracts with your insurance company and usually offer lower costs. Out-of-network providers: Do not have contracts with your insurer and often cost more. Some plans may not cover out-of-network care except in emergencies. Using in-network providers generally saves money.
It depends on your plan. Referral: Permission from your primary care provider to see a specialist. Prior authorization: Approval from your insurance company before certain services, procedures, medications, or treatments are covered. Plans such as HMOs often require referrals, while PPOs may not. Check your plan documents for specific requirements.
Most health plans cover prescription drugs, but coverage varies. A formulary is a list of medications covered by the plan. Drugs are often grouped into tiers: - Tier 1: Generic drugs (lowest cost) - Tier 2: Preferred brand-name drugs - Tier 3: Non-preferred brand-name drugs - Tier 4 or Specialty: High-cost specialty medications Your cost usually increases as you move to higher tiers.
Many health plans cover preventive services at no additional cost when received from in-network providers. Examples may include: - Annual wellness visits - Vaccinations - Blood pressure screenings - Cholesterol screenings - Certain cancer screenings - Well-child visits Coverage rules can vary, so verify with your insurer.
An Explanation of Benefits (EOB) is a statement from your insurance company that explains: - What services were provided - What the provider charged - What the insurance company paid - What amount, if any, you may owe An EOB is not a bill. If you owe money, you will usually receive a separate bill from the healthcare provider.
You can usually enroll or make changes during: Open Enrollment Period: A yearly window when anyone eligible can enroll or switch plans. Special Enrollment Period (SEP): Available after certain qualifying life events, such as: - Marriage - Divorce - Birth or adoption of a child - Loss of other health coverage - Moving to a new coverage area If you qualify for an SEP, you typically have a limited time to make changes.
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