What’s the process for getting coverage?

Published 11/06/2014 10:23 AM   |    Updated 10/27/2015 02:32 PM

What's the process for getting coverage?

You should take the following steps to ensure you select the right plan option, either on or off the federal Marketplace.

1. Review: Review your coverage and look for a letter from your plan about how your benefits and costs may change next year,

2. Update: Starting November 1, log in to the federal Marketplace and update your 2016 application - make sure your household income and other information is up-to-date for next year,

3. Compare: Compare your current plan with other plans that are available in your area,

4. Choose: Select the health plan that best fits your budget and health needs
Contact an insurance agent or certified Navigator to enroll in your plan. Make sure you discuss:

What doctors (providers) and are "in network"?

What hospitals are "in network"?

If there are medications you are currently taking, verify the medications are covered by the plan.

Each plan selected may use a different drug list known as a formulary. It is important to verify:

· Does the plan cover this medication?

· Is there a deductible associated with the medication?

· Is a prior authorization required in order to have this medication covered?

Request to look at a summary of the plan's offerings known as a summary of benefits and coverage. This document provides an overview of what is covered under the plan as well as any costs to you associated with using the benefits.

5. Enroll: Open enrollment both on and off of the federal Marketplace begins on November 1. Make sure to review, update, compare and choose by December 15, 2015, to be sure that any changes will take effect on January 1, 2016. Contact your plan after you've enrolled and make sure to pay your first month's premium.

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