Beyond Open Enrollment: Qualifying Life Events
You may have heard that the Open Enrollment Period for health insurance closed on January 31st. You might be wondering if you can still get health insurance. The answer is yes, but only if you have a Qualifying Life Event before the next Open Enrollment Period. We’re here to break it down for you and help you figure out your next steps.
What counts as a Qualifying Life Event?
Adding a Dependent
- Foster Care
- Receipt of a court order (including child support)
Loss of Other Health Coverage
- Expiration of a non-calendar year health insurance policy (even if you have the option to renew)
- Loss of pregnancy-related Medicaid coverage
- Beginning or ending service in AmeriCorps, VISTA, or NCCC
- Loss of Employer Sponsored Insurance (ESI)
- Loss of Washington Apple Health (Medicaid)
- Loss of a Qualified Health Plan due to permanent move
Did you know?
You can enroll in a plan up to 60 days before or after the loss of other coverage. But, be sure to wait until the month your other coverage will end so you don’t have a month of overlapping coverage.
If you move and become a resident of Washington or move to a new county in Washington that results in new plan options.
Did you know?
A permanent move to Washington State is only a qualifying event if you had minimum essential coverage for at least one day within the 60 days before you moved?
Change in Citizenship or Lawful Presence Status
If you become a citizen, national, or lawfully present individual, you may qualify for a Special Enrollment Period.
Did you know?
Those with tribal membership (American Indian or Alaska Native), may enroll in a QHP or change from one QHP to another once a month (and access other benefits)!
Release from Jail/Prison
If you have at least one individual on an application that changes status from incarcerated to no longer incarcerated you may be able to open a Special Enrollment Period to sign up for coverage.
Special Enrollment Periods Only Available to Existing Customers
If you already have an account on WAHealthPlanFinder and are enrolled in a plan you can report the following events to open up a Special Enrollment Period to change your plan. You cannot get a Special Enrollment Period with the following events if you are a first time applicant.
Losing a Dependent or Dependent Status
- Legal Separation
Filed or Reconciled Taxes
If you received tax credits in the previous year, you must have correctly filed a tax return even if you do not usually have to file taxes. If you do not file a tax return and reconcile the tax credit you received, you will lose the opportunity to receive a tax credit until the IRS has confirmed that you have filed your federal taxes.
Change in Income
If your income changes, you could lose or gain eligibility for (or change the amount of) health insurance premium tax credits (help paying your monthly premium).
Did you know?
If your income is below a certain amount, you may qualify for Washington Apple Health. If this is the case, you don’t have to wait for an Open Enrollment Period– you can sign up any time!
Don’t know where to start or what you qualify for? Give the Family Health Hotline a call at (800) 322-2588!
Estoy inscrito en Washington Apple Health ¿Qué sigue?
Dentro de un mes de inscribirse en Washington Apple Health, también recibirá una tarjeta blanca con el nombre de su plan de salud, que es la compañía de seguros por la cual recibirá su cuidado médico.
He oído a gente hablar de ProviderOne. ¿Qué es ProviderOne?
ProviderOne es el sistema computarizado que coordina sus planes de salud también conocido como “Managed Care”, que están disponibles bajo Washington Apple Health (Medicaid) . Si usted está inscrito en Apple Health, usted puede manejar su cobertura a través del Portal del Cliente ProviderOne . Los proveedores de salud también pueden utilizar el Portal del Cliente ProviderOne para comprobar y ver si está inscrito en Washington Apple Health.
Han pasado dos semanas y no he recibido mi tarjeta ProviderOne. ¿Qué debería hacer?
Si usted no ha recibido su tarjeta dos semanas después de que se haya inscrito, puede llamar a servicio al cliente por medio de línea de la Autoridad de Salud al 1-800-562-3022. La buena noticia es que todavía puede ir al médico y recoger las recetas antes de tener sus tarjetas. Usted sólo tendrá que ir a una clínica o farmacia que acepte Washington Apple Health (Medicaid) y su plan de salud. La clínica o farmacia puede buscar su Identificación de cliente ProviderOne sin la tarjeta y le preguntaran por su nombre, fecha de nacimiento y número de seguro social.
¿Cómo puedo saber a qué plan de salud me he inscrito?
Después de entregar su solicitud de Washington Apple Health usted tiene la oportunidad de elegir en cuál de los seis planes de atención administrada desea inscribirse. Si usted no sabe en qué plan desea inscribirse, no se preocupe; se le asignará un plan automáticamente durante la noche del día en que su solicitud es recibida, sin embargo, usted puede cambiar su plan si resulta que no es el que desea.
También recibirá un libro Medico de Beneficios llamado Healthy Options, con información sobre sus beneficios y planes disponibles en su área. También puede ver esta publicación como un archivo PDF.
¿Qué plan de cuidado administrado debería elegir?
Se requiere que todos los planes de cuidado administrado proporcionen un conjunto de servicios básicos, por lo que a la hora de elegir un plan de atención administrada puede ser útil tener dos cosas en cuenta:
● ¿Qué planes acepta su médico?
- Algunos médicos aceptan algunas coberturas de Washington Apple Health de cuidado administrado y otros no. Por lo tanto, es importante que llame a su médico o clínica para ver primero si aceptan Washington Apple Health, y si es así, qué planes de cuidado administrado toman.
● Beneficios Adicionales
- Además de los servicios básicos ofrecidos por todos los planes de atención médica administrada, los planes también proporcionan beneficios únicos adicionales que pueden ayudarle a tomar su decisión.
¿Cómo puedo cambiar los planes?
Hay maneras diferentes en las que usted puede cambiar los planes de cuidado administrado. Usted puede acceder a su ProviderOne Portal del Cliente, por correo o fax (1-866-668-1214) el formulario de registro incluido en el folleto de beneficios médicos Healthy Options, o llame a línea de Apple Health de Servicio al Cliente (1-800-562-3022).
¿Puedo seguir viendo a los mismos proveedores de atención médica con mi nuevo plan?
Su proveedor de atención médica sólo podrá aceptar ciertos planes de cuidado administrado, aunque generalmente aceptan Washington Apple Health (Medicaid). Llame a su médico para ayudar a determinar cuál es el plan que elegirá.
También puede llamar a su plan de atención administrada o visite su sitio web para obtener una lista de proveedores de cuidado de la salud en su área.
Open enrollment is here!
What do you need out of a Health Plan?
Health Plans are not one size fits all. If you plan on using your coverage only for preventive care, you may think that the cheapest plan is the best fit. But accidents happen—and they can lead to hefty out-of-pocket costs depending on the type of plan that you purchased. If you have existing health conditions or take prescription drugs, there are certain plans that can help keep your money right where it belongs: in your pocket. It can be helpful to think through all that you need from your health insurance before beginning the enrollment process so you end up with the best plan for you.
You may be eligible for subsidies to help you pay your premiums.
Worried about how having health insurance would impact your budget? You may be eligible for tax subsidies (also known as tax credits). Tax subsidies can help lower the cost of your monthly premium. You can apply these credits to your premium amount right away so that your monthly health insurance payment is affordable.
More plans means more competition–and that is a WIN for you and your budget!
There are a lot more plans to choose from this open enrollment period. Competition between these plans means that many plan premiums are lower that they were at last open enrollment. You should shop around even if you are already enrolled in a Health Plan. Even if you think your health plan is great, check out the other plans that are out there. Chances are, you will find a plan that is better and at a lower cost than the amount that you are already paying.
Avoid getting fined for not having health insurance.
Don’t pay a penalty for not having insurance coverage for you and your family. The fine for not having insurance in 2016 can cost you as much as $695 per uninsured person in your household or 2.5% of your yearly household income. That means that when you file your income taxes, the amount that you pay the IRS could increase fast! And if you anticipate a refund at tax time, the penalty can lower the amount that would otherwise go back into your pocket.
You may be eligible for free coverage today!
Depending on your income and other factors, you could qualify for immediate coverage. Washington Apple Health coverage is comprehensive and free, and will cover you today!
How can the WithinReach Family Health Hotline help?
Enrolling in a health plan can be confusing. Our friendly and knowledgeable staff can help you make sense of your options and apply for coverage for you and your family. Not only can we get you enrolled into affordable medical coverage over the phone, but we can also help you access other programs that can help you and your family stay healthy. Don’t hesitate to call the Family Health Hotline at 1-800-322-2588.
Calling on Mom: How do I find a doctor who takes Washington Apple Health?
If you have a doctor that you would like to continue seeing…
You will want to contact your physician’s office to see if they accept Apple Health and–if they do–if they have a preferred network. Asking these questions will guide your next steps and put you on the right track so you can continue to see your preferred physician.
If your preferred doctor DOES accept Apple Health…
That’s great! Now that you know your physician’s preferred Apple Health network, you will want to request enrollment into that network. For assistance and guidance regarding this process, you can call our Family Health Hotline at 1-800-322-2588.
When you’re ready to enroll in a specific network, you can call the Medical Assistance Customer Service Center at 1-800-562-3022 to enroll into a specific network or log into ProviderOne (make sure you use Windows Explorer as your browser) to switch your enrollment online.
If your preferred doctor DOES NOT accept Apple Health…
That’s too bad, but don’t panic! You have a few options to choose from. If you have yet to be assigned a specific network or Managed Care Health Plan, you can call our Family Health Hotline and we can find you a clinic in your area that accepts Apple Health. If you have already received your Managed Care Plan, you will have an assigned primary care provider (PCP) or clinic printed on the front of the card along with a contact number.
If you DO NOT have a preferred doctor…
You should be able to follow the same steps as if your provider does not accept Apple Health. You can contact our Family Health Hotline to find a clinic in your area who accepts the coverage or you can refer to your Managed Care Plan card to see the PCP you have been assigned to.
Keep in mind that you can always switch your Managed Care Plan if you do not like the plan that you are currently enrolled in or if you have already been in enrolled into a plan that your preferred physician does not accept. If you have any questions about your coverage and need help navigating your health insurance benefits, please call our Family Health Hotline at (800) 322-2588. We are here to help you!
For general information about your Apple Health coverage, read our other blog post, I Have Insurance Through Washington Apple Health. What Is Next?
Our resident Mom (also known as Chris Gray) is a fulltime mother to a rambunctious and curious 2 year old, and is expecting her second child in early March. During the day, she is also an Outreach and Enrollment specialist at WithinReach and a Certified Navigator. Chris has first-hand experience being enrolled in programs such as Apple Health and WIC. She also supports the Breastfeeding Coalition of Washington and is a Certified Lactation Educator.
Obstacles to Access: Tent City
Several residents of Tent City 3 shared that they were in need of dental care, but were having difficulty finding a dentist that would take their Apple Health insurance. We were able to use the WithinReach Resource Finder to pull up a list of providers for these clients to use; however, lack of regular internet and phone access makes finding accessible dental and health care an ongoing struggle.
Similarly, a woman enrolled in Washington Apple Health and Basic Food told us that she was unable to access her benefits because she had recently been a victim of theft. This is an issue that disproportionately affects the homeless, who often don’t have a secure place to store their belongings. Her cell phone and wallet were stolen while she was sleeping, leaving her without personal identification cards, insurance cards, Electronic Benefits Transfer (EBT) card, or a way to connect and replace these items. In this situation, simply contacting the various agencies in order to request replacement cards was a great challenge and a barrier limiting this woman’s access to health services and food.
Also that night, a 23-year-old woman we worked with was having difficulty accessing the prescription she needed to treat her bronchitis. People experiencing homelessness tend to be more susceptible to chronic illnesses, such as bronchitis, than those with stable housing. Without regular access to a mailbox, this young woman had not received her insurance card and had been denied prescriptions from her pharmacy, even though she has active coverage. We were able to offer suggestions about locations where she could receive mail in the future, and provided her with the phone numbers she needed to replace her insurance card.
Although the AmeriCorps team was able to offer short-term solutions to these clients so that they could access health and food resources, barriers to access, remain in place for the homeless population. These client interactions reminded me that simply signing a person up for benefits is often not enough; working around or removing barriers such as the lack of a mailbox or regular phone access is necessary for successfully connecting homeless clients. As we continue our outreach work with homeless communities, it is important to remember these common issues and try our best to work around them so that all of our clients can have access to health and food resources, no matter what their living situation is.
Need Shelter? Find Tent City sites here: http://www.sharewheel.org/Home/tent-cities
Tags: access AmeriCrops Basic Food Electronic Benefits Transfer (EBT) card Health care homeless communities ParentHelp123 resource finder Seattle Shelter Tent City 3 Washington Apple Health WithinReach
Coloring Isn’t Just for Kids
The last few weeks have been insanely busy for us. Responding to a wave of media requests in reaction to the recent measles, coordinating stakeholders across the state to help pass Breakfast After the Bell legislation, helping thousands of families apply for or renew their Apple Health coverage, bringing our experience and expertise with the Affordable Care Act to a Health Benefit Exchange Board meeting, attending listening sessions with the US Surgeon General, Vivek Murthy, MD, during his visit to Washington…..The list goes on and on – and our staff are always ready to step up, to say ‘yes’, to dig in and do more to make the connections WA families need to be healthy. Though this may be a recipe for success, it most certainly creates some stress.
That’s why I decided to share a recent Huffpost article at our staff meeting this week. The article, Coloring Isn’t Just For Kids. It Can Actually Help Adults Combat Stress., says that it has been found that coloring – that’s right, crayons and coloring books – has the power to reduce stress. In fact, the article says coloring “generates wellness, quietness and also stimulates brain areas related to motor skills, the senses and creativity”.
Many of us are ‘yellow pad doodlers’, so this makes sense. Not only did I share the article, but I offered staff the opportunity to color during staff meeting and beyond. Staff jumped in, and the accompanying picture highlights the result of our staff meeting coloring.
I realize coloring will not reduce the demands placed on our staff, or the crazy fast pace with which they work, but perhaps it brought a small moment of quietness to the day – and hopefully, the message that we care about the health and well-being of all WA families – including our own.
Tags: Affordable Care Act Breakfast After the Bell coloring creativity Health Benefit Exchange Huffpost Measles stress-relief vaccines Washington Apple Health Washington families Washington state WithinReach
Being Prepared Over Feeling Invincible: Why Medical Insurance Is Important While You Are Young
Not Having Health Insurance Might Impact Your Family’s Finances!
Health insurance is a very broad term and could encompass a variety of health insurance plans. For the purposes of the Affordable Care Act health insurance coverage is determined by a standard called “minimum essential coverage”. If a health plan has this label, it means that it has met the federal standard of a quality health insurance plan. For many people the establishment of minimum essential coverage plans now provides a higher quality and broader scope of service from their health insurance providers than what was available prior to the Affordable Care Act. All minimum essential coverage plans must cover 10 essential health services that are outlined here. For a large number of people, the minimum essential coverage requirement has been met through their existing health plan. If not, the Affordable Care Act has created new health plan options.
Common types of minimum essential coverage:
- The vast majority ofemployer-sponsoredhealth plans
- All of theprivate health plans offered through the Washington HealthPlanFinder
- Apple Health plans offered through the Washington HealthPlanFinder
- TRICARE plans offered through the US Military
For some people, there will be no changes in their health plans or how they apply for health insurance. But for 41 million uninsured Americans , the enactment of the Affordable Care Act has opened new doors to affordable, accessible and quality health insurance coverage. In Washington State, new health insurance plans are now offered through the Washington HealthPlanFinder with government subsidies such as tax credits and cost sharing reductions to make the insurance more affordable for most individuals and families. Other programs, like Washington Apple Health, have expanded to allow more people to enroll in free and low-cost health insurance. These new options present viable opportunities for health insurance that have not existed in the past.
What happens if I did not get health insurance?
If an individual or family was not able to enroll in a health insurance plan in 2014, they could face a fee when they file their 2014 taxes. This fee acts as the enforcement piece of the Affordable Act Care and it is commonly referred to as the individual responsibility requirement. In order to make health insurance affordable and accessible to everyone, the majority of people need to participate. Fees acts as a way to hold each other accountable and keep the overall cost of health insurance low. The amount of the fee will vary by household. The basic fee schedule for not having health insurance in 2014 and 2015 is:
Are there any other options?
The fee is not designed to punish people that cannot afford health insurance or have experienced hardship. There are a number of reasons why someone may not have been able to enroll in health coverage over the past year. In response to the unique needs of individuals and families, the federal Health Insurance Marketplace offers exemptions that allow people to go insured for short periods of time or to be completely exempt from the individual responsibility requirement and therefore exempt from paying any fees associated with not having health insurance.
To find out more about the exemptions offered through the Health Insurance Marketplace and how to apply for them, call the Family Health Hotline at 1-800-322-2588 or contact us through our website: ParentHelp123.org
2015 Open Enrollment for the Washington HealthPlanFinder is happening now to February 15th. Call the Family Health Hotline to speak to a Health Insurance Navigator about your options: 1-800-322-2588.
 Kaiser Family Foundation. Key facts about the uninsured population. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Tags: ACA Affordable Care Act Family Health Hotline fee exemption options Health Coverage Health Fee health insurance Health insurance enrollment marketplace ParentHelp123 TRICARE uninsured Washington Apple Health Washington HealthPlanFinder Washington state
I bought health insurance through the Washington Healthplanfinder. What’s next?
Written by Erin Milliren and Natasha Pietila
Question: I’ve enrolled in health insurance through the Washington Healthplanfinder. What happens next?
Answer: You can expect to receive your health insurance cards in the mail, along with information from your health insurance company and an eligibility letter from the Washington Healthplanfinder. Depending on the type of health insurance you are enrolled in, you will receive different information and items in the mail.
If you are enrolled in a Qualified Health Plan (i.e. a paid plan) you will receive the following information:
1) A card from the plan you selected and bought
2) You can also expect to receive information from that insurance company about your coverage
3) You will either receive an email or letter from the Washington Healthplanfinder stating which insurance plan you purchased and listing your coverage start and end dates
Question: When I submitted my application I was told that I’m eligible for tax credits. What does this mean?
Answer: It sounds like you are eligible for the Health Insurance Premium Tax Credit (HIPTC) which is designed to make your insurance options more affordable.* The amount of the credit is estimated instantaneously by the Healthplanfinder, based on the information you reported on your application. It is important that you update your income, if it changes, because the IRS will verify the tax credit amount when you file your taxes. The IRS Facts About The Premium Tax Credit sheet explains how you can use this tax credit:
– Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what you pay out-of-pocket for your monthly premiums during 2014; or
– Get It Later: wait to get the credit when you file your 2014 tax return in 2015
All of these methods can be managed on your Washington Healthplanfinder account.
*For a brief explanation about the purpose of the HIPTC, you can refer to this information from the Federal Government.
Here’s a review of what to expect when you become enrolled in Washington Apple Health:
If you are enrolled in Washington Apple Health (i.e. Medicaid) you will receive the following information:
1) A blue ProviderOne card, which is imprinted with information about your Medicaid coverage
2) A card from the Managed Care Provider (i.e. insurance company) to whom you will be assigned. There are five Managed Care Providers: Amerigroup, Community Health Plan, Coordinated Care, Molina, and United Healthcare
3) You can also expect to receive a Healthy Options booklet which contains information about your coverage
4) You will either receive an email or letter from the Washington Healthplanfinder stating that you are enrolled in Washington Apple Health and listing your coverage start and end dates
For more information, please see our blog post specifically dedicated to Apple Health.
Question: How long does it take to receive my health insurance cards?
Answer: According to Washington’s Healthcare Authority it will take about a month after your completed Apple Health enrollment to get you all set up with your health plan. If you need to go to a doctor or fill a prescription before your cards arrive, you can go to any doctor, health clinic, or pharmacy that accepts Apple Health. If you tell a provider or pharmacist your name, date of birth, and Social Security number, they can look you up online and find your ProviderOne client number.
You can find healthcare providers in your area at ParentHelp123.org.
Pregnant Teens and Washington Apple Health for Pregnancy: How to Apply!
Written by WithinReach Bilingual Outreach and Enrollment Specialist José Villalobos
• Prenatal care
• Post pregnancy follow-up
• Dental care
• One year of family planning services
• Newborns receive one year of full medical
This program also provides enhanced services such as Maternity Support Services, Infant Case Management and Childbirth Education. Teens looking to apply for coverage worry about having to report their parent’s income but for this program, no income or resource limits are taken into consideration. Any Washington State resident under 19 and pregnant is eligible! To apply, click on the following link, fill-out the form and send it to the Health Care Authority. Pregnant Teen Health Care Coverage. If you have any questions feel free to contact the WithinReach Family Health Hotline at 1-800-322-2588 to speak with our friendly and knowledgeable staff.
Health Insurance Enrollment: Which Dates Matter?
Yes. You may qualify for coverage that is of no cost to you, or coverage that will require you to pay a premium. The Affordable Care Act requires most U.S. citizens and legal permanent residents* to have health insurance coverage for at least 9 months of the year. Therefore, it would be best to enroll by the March 23 deadline so as to get coverage by April 1st and avoid paying a penalty on your 2014 taxes.
I have insurance through my employer at this time, but there is a chance that I will be laid off in the next few months. Will I be able to enroll in insurance after March 23rd without receiving a penalty?
Yes. Certain qualifying events like the loss of a job enable you to enroll without a penalty. For a list of other qualifying events, please refer to this list from the Federal government. Also, if you qualify for free coverage through Washington Apple Health (aka Expanded Medicaid), you need not worry since Washington Apple Health enrollment remains open, year-round.
*The Affordable Care Act mandates that Americans have health insurance, beginning in 2014. Those without insurance may be required to pay a penalty on their 2014 taxes. Some may be exempt from this mandate and will not have to pay a penalty if they do not have health insurance. For more information on these exemption eligibility requirements, please refer to this infographic from The Kaiser Family Foundation.
2014 Legislative Session Week Two – Innovation in our Health Care System
But as the saying goes, this is not the end. This is not the beginning of the end. This is the end of the beginning.
There is so much more that we can and must do to improve the health of our families. One of the next major steps to create some wide level change in our health care systems. The current system is segmented, doesn’t utilize effective payment and delivery models, and doesn’t focus on prevention first.
It is with this in mind that Washington State applied for, and was awarded, a State Innovation Model grant from the Center for Medicare and Medicaid Innovation (CMMI). With this grant, health care leaders from across Washington state came together to create the State Health Care Innovation Plan.
This plan has the three main goals of better health, better care, and lower costs for Washingtonians. To achieve this, our State will take on the different strategies of value-based purchasing, building healthy communities and people through prevention early mitigation, and better integration of health care and social supports, especially in the area of integrating physical and behavioral health needs.
These goals are shared by WithinReach and our staff has a lot of experience working with families who have seen the best and the worst of our current health care system. By transforming the system to better meet health care needs in an effective and more affordable way, we can help Washington families have better health outcomes.
Last week, legislation was introduced into the State House of Representatives to develop and implement the five-year State Health Care Innovation Plan. Getting this bill (House Bill 2572) passed is a necessary and important step toward getting this plan in motion. You can follow the progress of this bill by checking in here. It has already been scheduled for a hearing on January 27th in the House Committee on Health Care and Wellness, which you can watch on TVW.
It is an exciting time in the health care world! Through the great ideas and strategies in the State Health Care Innovation Plan, our state can begin to transform the system and create better, healthier lives for our friends, families, and communities.