The Medical Center Enterprise seeks to educate and enroll uninsured community members
As part of the Affordable Care Act, most US citizens were required to obtain health insurance starting in 2014. In 2015, there is a penalty if you are not excluded for a specific reason. Wondering why health insurance is so important, we met with Rich Ellis, CEO of Medical Center Enterprise to find out.
As part of the Affordable Care Act, most US citizens were required to obtain health insurance starting in 2014. In 2015, there is a penalty if you are not excluded for a specific reason. Wondering why health insurance is so important, we met with Rich Ellis, CEO of Medical Center Enterprise to find out.
What is health insurance?
Ellis
Health insurance is a contract between you and an insurance company. When you buy a plan or policy, you pay a monthly fee, and in return, the company agrees to pay part of your medical expenses when you become ill or injured.
Health insurance is a contract between you and an insurance company. When you buy a plan or policy, you pay a monthly fee, and in return, the company agrees to pay part of your medical expenses when you become ill or injured.
Why is it important that citizens have health insurance?
Ellis
While no one plans an injury or injury, most people will need medical attention at some point. Did you know that the average cost of a three-day hospital stay is $ 30,000? Or can a broken leg repair cost $ 7,500? Health insurance protects you from unexpected costs like these. Your insurance policy will determine the types of care, treatment and services that are covered, including the amount that the insurance company will pay for different treatments in different situations.
Is health insurance compulsory?
Ellis
Yes, with a few exceptions, most U.S. citizens are required to obtain health insurance under the Patient Protection and Affordable Care Act, which was enacted in 2010. Those who do not have the minimum basic health coverage, As through an employer, they don't do this if he qualifies for an exemption, they must pay penalties if they don't have health insurance.
What is this punishment?
Ellis:
If you can afford health insurance coverage in 2015, but don't participate, you'll have to pay a fine ($ 325 per adult, $ 162.40 per child, up to $ 975 per family, or 2% of income, whichever is greater) . Without insurance, you will be financially responsible for all of your medical costs.
Who is exempt from health insurance?
Ellis
The list is long, but here are some reasons why a person could be an exception:
- Coverage Unsustainable coverage (over 8% of household income)
- You are a member of a federally recognized tribe
- You are below the minimum tax deposit and are not required to provide tax
- You are uninsured for less than three consecutive months during the year.
When can a person buy health insurance?
Ellis
For the health insurance market, the registration periods are only for a specific period during the year. The next enrollment period is November 15, 2014 through February 15, 2015. You can only purchase insurance outside of that period if you have a life-qualifying event, such as marriage, divorce, newborn, and income change , to name just a few.
You are included if you have Medicare, Medicaid, CHIP, any work-based plan, any plan you bought yourself, COBRA, retiree coverage, Tricare, VA health coverage.
How much does health insurance cost?
Ellis
Each plan varies in terms of total cost and depends on the premium and deductible amount you choose. The fee is the amount of money that is raised against a certain amount of insurance coverage each year. You can also have an annual discount. This is the amount you must pay out of pocket before the insurance company pays the expenses. For example, suppose you have a $ 200 discount plan. She goes to the doctor and the total cost is $ 250. You pay the first $ 200 to cover the deductible amount, then your insurance pays its share. The amount you pay for the insurance premium and discount depends on the type of insurance you have and whether you are purchasing individual or family coverage.
What types of plans are there?
Ellis
There are four levels of eligible health plans in the health insurance market: platinum, gold, silver, and bronze. Each category costs different monthly fees, as well as deductibles. There are many affordable options in the health insurance market and you can compare each plan side by side so that you can find the plan that meets your and / or your family's needs.
Is there any help available if I can't afford health insurance?
Ellis
The federal government can help some individuals and families with their premium costs by supporting those who qualify based on income.
For example, if the income of a family of four was approximately $ 40,000 in 2014, they may be eligible for help with tuition costs greater than 5% of their income. If the same family of four buys a silver plan that can cost them about $ 9,400 per year, they may be eligible for support assistance of about $ 7,400; This means that you will only be responsible for approximately $ 2,000 of the cost of the premiums.
The federal government can help some individuals and families with their premium costs by supporting those who qualify based on income.
For example, if the income of a family of four was approximately $ 40,000 in 2014, they may be eligible for help with tuition costs greater than 5% of their income. If the same family of four buys a silver plan that can cost them about $ 9,400 per year, they may be eligible for support assistance of about $ 7,400; This means that you will only be responsible for approximately $ 2,000 of the cost of the premiums.
What if you have a previous condition, such as a previous cancer, a diagnosis of diabetes, or a pregnant woman?
Ellis
You cannot be excluded from coverage for any pre-existing conditions. Equally important, parents can cover their children up to age 26 with their insurance plan.
What should I do if I enrolled last year and have coverage?
Ellis
The federal government announced that for consumers who already enrolled in the Marketplace plan in 2014, they will have the option of automatic enrollment to determine the same coverage as the health plan in 2015. Of course, these individuals and families also have the option to buy other coverage options. Market registration tools describe the steps consumers will need to take, either for the automatic registration option in the same health insurance coverage, or to buy other options.
What does medical insurance cover?
Ellis
In addition to pre-existing conditions, all eligible health plans must submit:
- Mobile patient services
- Hospital and emergency services.
- Maternity and newborn care
- Mental health and substance use disorder
- Prescribed medication
- Laboratory services
- Preventive and wellness services
- Management of chronic diseases.
- Pediatric services, including dental and vision care.
Of course, you must meet the deduction before paying the insurance.
I also heard that eligible health plans cover free preventive care services
Ellis
Yes, qualifying plans cover many checkups, tests, and preventive care services, like vaccinations, that can help adults and children stay healthy. The best news is that it is free, with no subscriptions or discounts. Depending on your age, gender, and other risk factors, your doctor may tell you that it is time to have a mammogram, a colonoscopy, or any other test that can detect cancer or disease in its early and most treatable stages. Or it may be time to control high blood pressure or high cholesterol to give your doctor information that can help prevent a stroke or heart attack.
For women, many preventive care checkups, tests, and supplies that can help with family planning and pregnancy are now covered, along with services like:
- Woman checks are good
- Contraception and birth control counseling.
- Screening during pregnancy for a variety of conditions
- Supplies, support and advice for breastfeeding
In addition to the health insurance plan in the health insurance market, what other types of health insurance are available?
Ellis
Many low-income families will qualify for Medicaid or CHIP and can enroll at any time of the year. Medicaid provides health coverage to some low-income families, families, children, pregnant women, the elderly, and people with disabilities. In some states, the program covers all low-income adults below a certain income level. CHIP provides low-cost health coverage for children in families who earn a lot of money to qualify for Medicaid. In some states, CHIP covers parents and pregnant women. Each state provides CHIP coverage and works closely with its Medicaid program.
Many low-income families will qualify for Medicaid or CHIP and can enroll at any time of the year. Medicaid provides health coverage to some low-income families, families, children, pregnant women, the elderly, and people with disabilities. In some states, the program covers all low-income adults below a certain income level. CHIP provides low-cost health coverage for children in families who earn a lot of money to qualify for Medicaid. In some states, CHIP covers parents and pregnant women. Each state provides CHIP coverage and works closely with its Medicaid program.
How can local and uninsured residents find help registering?
Ellis
As a service to our Community Medical Center Foundation, it can help uninsured residents review coverage options in the health insurance market or determine Medicaid eligibility. We can also assist in re-registration or private registration if a person has changed in their life, such as marriage, divorce, job loss, etc.
All they need is to make an appointment with one of our application coordinators by calling us at 8716-393-8716. We also have Spanish-speaking representatives to help.
About the Medical Center Foundation
Medical Center Enterprise is a 113-bed progressive intensive care hospital offering a full range of health services to Enterprise, Fort. Roker, Coffee County and surrounding areas. Technology and trained professionals come together to provide compassionate, customer-focused care. Primary services include gynecology, obstetrics, emergency medicine, orthopedics, digital mammography imaging, general surgery, physical therapy, family medicine / internal medicine, and senior care. The Foundation Medical Center is located at 400 N
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