9 Simple Facts about Health Insurance

Fact #1

Open Enrollment for 2015 individual health insurance plans begins November 15, 2014.

Fact #2:

You may apply for coverage outside the dates of Open Enrollment if you have a qualifying event.

Fact #3:

All individual and small group health insurance plans effective on or after January 1, 2014 must include coverage for 10 essential health benefits — things like preventive care, well visits to the doctor, hospitalization, etc.  Click here for the full list.

Fact #4:

Health insurance plans, even those purchased through the federal or state exchanges (marketplace plans), are run by private health insurance carriers.

Fact #5:

If you need help paying for your coverage, you may be eligible for a premium subsidy, depending on your income.  To collect a subsidy you must purchase your plan through your state’s exchange.  Virginia residents use the federal health insurance exchange, healthcare.gov.  Maryland and DC have their own exchanges.

Fact #6:

Starting on January 1, 2014, you cannot be denied health insurance coverage because of a pre-existing medical condition.  This is known as guaranteed issue.

Fact #7:

Starting on January 1, 2014, you cannot be charged a higher premium because of your gender; men and women pay the same premiums.

Fact #8:

If you purchased a marketplace plan and are collecting a subsidy for your coverage, you must report any changes in income or family status that might have an impact on your eligibility for the subsidy.  Click here to learn more.

Fact #9:

Although your insurance carrier will offer automatic re-enrollment in your current plan (or one similar to it) when your coverage expires, you should carefully review your options before selecting a new plan.  You can compare your options — including premiums, deductibles, out-of-pocket costs, etc.–  using our convenient Instant Quote feature:

Virginia Medical Plans is a one-stop shop for your health insurance!

Call us at 1-800-867-0800 or email us at jkatz@vamedicalplans.com for assistance in finding the right coverage for you.

Which Preventive Services and Immunizations Are Covered for Children Under ACA?

Now that you have health insurance, you may be wondering what’s covered and what’s not for your dependent child(ren).

By law (namely, the Affordable Care Act — ACA), certain preventive services for children through age 18 must be covered at 100%.  This means no copayment, no coinsurance charge, and regardless of whether or not you have met your annual deductible.

Your child must receive these services from an in-network provider for your plan to cover 100% of the charge.

Preventive Services for Children

Here is a list of the preventive services that must be covered for children ages 18 and under:

TYPE OF SERVICE	DETAILS
Alcohol and Drug Use Assessment	For adolescents ages 11-18.
Autism Screening	At ages 18 months and 24 months
Behavioral Assessments	At ages 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years
Blood Pressure Screening	For children at recommended ages: 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years
Congenital Hypothyroidism Screening	Once at birth
Cervical Dysplasia Screening	For sexually active females
Depression Screening	For adolescents
Developmental Screening	For children under age 3; continued monitoring throughout childhood
Dyslipidemia Screening	For children at higher risk for lipid disorders at ages 1-4 years, 5-10 years, 11-14 years, 15-17 years
Fluoride Supplements	For children without fluoride in their water source
Gonorrhea Preventive Medication	For all newborns, once at birth
Hearing Screening	For all newborns
Height, Weight, Body Mass Index	For children at ages 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years
Hematocrit or Hemoglobin Screening	For children
HIV Screening	For adolescents at higher risk
Immunizations	As recommended (see below)
Iron Supplements	For children ages 6-12 months at risk for iron deficiency (anemia)
Lead Screening	For children at risk of exposure
Medical History	For all children throughout development
Obesity Screening and Counseling	For all children
Oral Health Risk Assessment	For young children at ages 0-11 months, 1-4 years, 5-10 years
Phenylketonuria (PKU) Screening	For newborns
Sexually Transmitted Infection (STI) Prevention Counseling and Screening	For adolescents at higher risk
Tuberculosis (TB) Testing	For all children at higher risk
Vision Screening	For all children

Note: Some grandfathered plans are not required to cover all services.

Immunizations for Children

Here are the covered immunizations for children up to age 18.  These are covered at 100%, with no copayment, no coinsurance charge, and regardless of whether or not you have met your deductible.  The immunization must be given by an in-network provider to be covered at 100%

IMMUNIZATIONS – VACCINES FOR CHILDREN AT RECOMMENDED AGES
Diphtheria, Tetanus, Pertussis/Whooping Cough (DTP)
Haemophilus Influenza Type B
Hepatitis A
Hepatitis B
Human Papillomavirus (HPV)
Influenza (Flu Shot)
Measles, Mumps, Rubella (MMR)
Meningococcal (Meningitis)
Pneumococcal
Polio (Inactivated Poliovirus)
Rotavirus
Varicella (Chicken Pox)

Note: Some grandfathered plans are not required to cover all services.

Check Your Policy Information

For more detailed information, check the documentation you received with your policy.  Be sure you understand what your plan covers before you seek medical treatment, so there are no surprises later!

Give our office a call or send us an email if we can answer any questions for you.

Click here for a list of preventive services and immunizations covered for adults.

Click here for a list of preventive services covered for women.

Which Preventive Services and Immunizations are Covered for Adults Under ACA?

Now that you have health insurance, you may be wondering what’s covered and what’s not.

By law (namely, the Affordable Care Act — ACA), certain preventive services must be covered at 100%.  This means no copayment, no coinsurance charge, and regardless of whether or not you have met your annual deductible.

You must receive these services from an in-network provider for your plan to cover 100% of the charge.

Preventive Services for Adults

Here is a list of the covered preventive services for adults:

TYPE OF SERVICE	DETAILS
Abdominal Aortic Aneurysm Screening	One-time for men of specified ages who have ever smoked
Alcohol Misuse	Screening and counseling at physical exam
Aspirin Use	To prevent cardiovascular disease, for men and women of certain ages
Blood Pressure Screening	For all adults
Cholesterol Screening	For adults of certain ages or at higher risk
Colorectal Cancer Screening	For adults over 50
Depression Screening	For all adults at physical exam
Type 2 Diabetes Screening	For adults with high blood pressure
Diet Counseling	For adults at higher risk for chronic disease
HIV Screening	For all adults at higher risk
Immunizations	As recommended (see below)
Obesity Screening and Counseling	For all adults during physical exam
Sexually Transmitted Infection (STI) prevention	For adults at higher risk
Tobacco Use	Cessation counseling and intervention for all adults
Syphilis	Screening for all adults at higher risk

Note: Some grandfathered plans are not required to cover all services.

Immunizations for Adults

Here are the covered immunizations for adults.  These are covered at 100%, with no copayment, no coinsurance charge, and regardless of whether or not you have met your deductible.  The immunization must be given by an in-network provider to be covered at 100%

IMMUNIZATIONS – VACCINES FOR ADULTS AT RECOMMENDED AGES
Diphtheria, Tetanus, Pertussis/Whooping Cough (DTP)
Hepatitis A
Hepatitis B
Herpes Zoster (Shingles)
Human Papillomavirus (HPV)
Influenza (Flu Shot)
Measles, Mumps, Rubella (MMR)
Meningococcal (Meningitis)
Pneumococcal
Varicella (Chicken Pox)

Note: Some grandfathered plans are not required to cover all services.

Check Your Policy Information

For more detailed information, check the documentation you received with your policy.  Be sure you understand what your plan covers before you seek medical treatment, so there are no surprises later!

Give our office a call or send us an email if we can answer any questions for you.

Click here for a list of preventive services and immunizations covered for children.

Click here for a list of preventive services covered for women.