Q & A for Oakwood's Health Care Navigators

How can I enroll in health insurance on the Marketplace?

There are multiple ways to enroll. You can do so online at www.healthcare.gov, over the phone at 1-800-318-2596 or in person with a navigator. We have two federally-certified navigators who can help you. Contact Us: Katie Mauro: 313-586-5218 or Keith Bouck 313-586-5488                                                   
Address: Oakwood Corporate Services, 15500 Lundy Parkway, Dearborn, MI 48126

Who is eligible for financial assistance to help purchase insurance through the Marketplace?

Under the Affordable Care Act, individuals who purchase insurance after January 1, 2014 through a Marketplace account will be eligible for subsidies for health insurance premiums and cost-sharing if their income is between 100 – 400% of the federal poverty level (FPL) – (100% of the PFL is $11,490, 400% for a household of four is $94,200).

What is the deadline for enrollment in the Marketplace?

The deadline for the open enrollment period is March 31st. After the deadline, an individual will not be able to purchase coverage until the next open enrollment period unless they a special qualifying life event.

What if I have employer insurance but it is really expensive?   

Individuals who get insurance through their employer can get subsidized coverage in a Marketplace if their premiums are unaffordable (more than 9.5 percent of their household income) or the plan is inadequate (pays less than 60 percent of the cost of covered benefits).

What are the Essential Health Benefits?

The ACA established a package of Essential Health Benefits (EHB) that must be covered in all plans offered in the Marketplace. The law says that EHBs have to cover at least the following categories:

1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)
2. Emergency services
3. Hospitalization
4. Maternity and newborn care (care before and after your baby is born)
5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
6. Prescription drugs
7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

What happens to Medicaid with the ACA?

Beginning in spring 2014, individuals under age 65 with incomes up to 133% of the Federal poverty level (FPL) will be eligible for Medicaid in Michigan. The expanded Medicaid program is also known as ‘Healthy Michigan’. The application for ‘Healthy Michigan’ is still unavailable and is suppose to be ready at some point in April.

What happens if I choose not to purchase insurance?