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No health insurance? See if you qualify for a Special Enrollment Period

If you have certain types of life changes — like losing health coverage, moving, getting married, or having a baby — you may qualify for a Special Enrollment Period to enroll in a Marketplace plan for the rest of 2018.

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Do you qualify for a Special Enrollment Period?

If you already know you qualify, start an application:

Attention: Tax day is less than one week away!

Don’t miss the April 17, 2018, deadline to file 2017 taxes and report your health coverage! No matter how you got health coverage — whether through the Marketplace, your job, or another source — you must report your 2017 coverage status to the IRS when you file taxes.

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Get step-by-step directions & tax forms:

Tax help is available:

5 tips to prepare for doctor’s visits

Visiting the doctor soon? Here are 5 things you can do to get ready.

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Get ready for your doctor’s visit

  • Bring your insurance card with you. After you enrolled in a plan, you should have gotten a card or other proof of your insurance in the mail. (If you didn’t get a card, contact your health plan.)
  • Know your family health history. Share with your doctor any family health history and medical records, if you have them.
  • Make a list of any medicines you take. Make sure to tell your provider the dosages.
  • Bring a list of questions and things to discuss. Write down your questions or concerns in advance. You may want to bring a friend or family member with you to help.
  • Take notes. Jot down any questions that come up during your appointment. Don’t leave until all of your questions have been answered and you understand what to do next.

For more tips on preparing for your doctor’s visit, read our "From Coverage to Care: A Roadmap to Better Care and a Healthier You" (PDF).

4 steps to find the provider that’s right for you

Choosing a provider you trust is one of the most important decisions you’ll make about your health care, and finding the right one can take a little work. Follow these 4 steps to help you choose:

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How to find a doctor you trust

  1. Get a list of in-network providers: Call your insurance company or look at their plan materials for a list of doctors in their network. You’ll usually pay less to see a doctor in your network than a doctor who’s out-of-network.
  2. Do your research: Ask friends and family if they recommend their doctors. You may even be able to read online reviews for doctors in your area.
  3. Call the office for more information: Call the doctor’s office and ask them any questions you have to help you decide. Make sure they accept new patients and your health coverage.
  4. Make an appointment, and give them a try: When you call to make your appointment, have your insurance card on hand. It might take more than one visit to figure out if a doctor is the right one for you.

Learn more about finding a provider and making an appointment (PDF).

3 Tips: Knowing where to go for medical care

You can get health care in many different places, but it’s best to get routine care from a primary care doctor. Visiting your primary care doctor usually costs much less than visiting the emergency room, and you’ll spend less time waiting. Check out these 3 tips to know where to go for medical care:

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Where to go based on the care you need

  • For routine care, visit a primary care doctor: They’ll work with you to make sure you get the right preventive services, manage any chronic conditions, and improve your overall health and well-being.
  • Before getting care, know you’re covered: Call the office before you visit to make sure they see patients with your coverage. Not all doctors and hospitals take all insurance plans or types of coverage. Learn about finding a doctor in your plan.
  • In an emergency or life-threatening situation, call 9-1-1: In an emergency, get care from the closest hospital that can help you. They’ll treat you even if you don’t have any insurance.

Get more information on knowing where to go for care.

What your health insurance card tells you

After you enrolled in Marketplace insurance, you probably got a membership package in the mail with information about your coverage. You may have also gotten a card or other document as proof of your insurance. (If you didn’t get a card, contact your health plan.)

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3 things to know about your membership package & insurance card

  • Read your membership materials carefully: You may need them when you see a doctor or if you call your insurance company with questions. If you don’t understand the materials you got, call your health plan and ask them to explain.
  • Review your insurance card: It shows your member and group numbers, your plan type, and a phone number to call for questions about finding a doctor or what your plan covers.
  • Store your insurance card in a safe place: If someone else uses your insurance card or member number to get prescription drugs or medical care, they’re committing fraud.

Learn more about understanding your membership (PDF) and plan materials.

Understanding key health insurance terms

Insurance plans can differ in which providers you can see and how much you have to pay. It’s important to understand your costs and key health insurance terms, so you’ll know what services your plan will pay for and how much each visit or medicine will cost.

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Important key words explained

  • Deductible: The amount you owe for covered health care services before your health insurance or plan begins to pay.
  • Copayment: An amount you pay as your share of the cost for a medical service or item, like a doctor's visit.
  • Coinsurance: Your share of the cost for a covered health care service, usually calculated as a percentage (like 20%) of the allowed amount for the service.
  • Premium: The amount you pay for your health insurance or plan each month.
  • Network: The doctors, hospitals, and suppliers your health insurer has contracted with to deliver health care services to their members.

Browse our glossary for more health insurance definitions, and get more information on how your costs work together.

Put your health first: Using your 2018 Marketplace insurance

You can use your Marketplace health insurance when you’re sick and when you’re well. Follow these tips to help maintain your health:

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Put your health first

  • Take advantage of free preventive services: Preventive care, like shots and screening tests, is free with your Marketplace plan when delivered by a doctor or provider in your plan’s network.
  • Improve your mental and emotional well-being: All Marketplace plans cover mental health and substance abuse services as essential health benefits.
  • Stay organized: Use this booklet (PDF) to keep all your health information in one place. This helps you easily track your coverage information and care.

Get more information on using your Marketplace coverage

How to “reconcile” your premium tax credit on 2017 taxes

If you had 2017 Marketplace coverage, you should have already received Form 1095-A in the mail. Make sure your Form 1095-A is accurate before you file your taxes. You’ll use information from this form about the second lowest-cost Silver Plan (SLCSP) to complete Form 8962, Premium Tax Credit.

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First: Verify your household and coverage information & SLCSP

To make sure your SLCSP is correct, look at Part III, Column B of your 1095-A, titled “Monthly second lowest-cost Silver Plan (SLCSP) premium.” The SLCSP premium is incorrect if:

  • Part III, Column B has a “0” or is blank for any month someone in your household had the Marketplace plan.
  • You had changes in your household that you didn’t tell the Marketplace about — like having a baby, moving, getting married or divorced, or losing a dependent.

If either applies, use our tax tool to get your SLCP premium.

If anything about your coverage or household is wrong on your Form 1095-A, contact the Marketplace Call Center.

Second: “Reconcile” on your taxes

Now that you know your Form 1095-A is accurate, you’re ready to file. If you had a Marketplace plan and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you’ll have to "reconcile" when you file your federal taxes.

See a step-by-step guide to reconciling.

What to do if Form 1095-A is wrong

You should have already received Form 1095-A in the mail. This form may also be available online in your Marketplace account. Before you file your 2017 taxes, make sure your Form 1095-A is accurate. Don’t file 2017 taxes until you have a correct 1095-A. If it has errors, contact the Marketplace Call Center, and you’ll be sent a corrected Form 1095-A.

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How to check Form 1095-A for accuracy

  • Verify basic information about your health plan and household members on Parts I and II of the form.
  • Make sure the premium for the second lowest-cost Silver plan (SLCSP) is correct. See how to check your SLCSP.
  • If it’s not, you’ll use our tax tool to get your SLCSP.

Get more information on using Form 1095-A.

Already filed with an incorrect form?

You may need to file an amended return using the information on your corrected 1095-A. Learn about amending returns from the IRS.


News – Insurance Journal

Connecticut Pizza Shop Owner Pleads Guilty to Fraud Stemming From Fire
The owner of a Connecticut pizza parlor has pleaded guilty to a fraud charge for setting fire to his own business and then collecting insurance money. Federal prosecutors say 32-year-old Mustafa Zabana, an Iraqi national living in Westfield, Massachusetts, pleaded …

POSTED APRIL 23, 2018 1:12 PM
Three Men Sentenced in Delaware Murder-For-Hire Scheme
Three men found guilty in a murder-for-hire scheme in Delaware have been sentenced. News outlets report 46-year-old Ryan Shover, 53-year-old Michael Kman and 55-year-old Paul Disabatino are the last of four men sentenced in the plot in which 43-year-old Wayne …

POSTED APRIL 23, 2018 1:07 PM
N.J. High Court Rules That Phantom Vehicles Can Be Allocated Fault
The case of Mark R. Krzykalski v. David T. Tindall involves an auto accident where both the plaintiff and the defendant were in the left lane turning left through an intersection. An unidentified driver turned unexpectedly from the right lane, …

POSTED APRIL 23, 2018 12:57 PM
MGAA Launches Chrysalis Initiative for Next Generation of Insurance Professionals
The UK-based Managing General Agents’ Association (MGAA) hopes its launch of Chrysalis, a dedicated community for MGAs to share innovation and expertise, will represent the interests of the next generation of industry professionals. The group sees Chrysalis encouraging change through …

POSTED APRIL 23, 2018 12:12 PM
Hartford Insurtech Hub Gives 10 Startups Shots at Partnerships with Insurers
Emerging from a 10-week accelerator program, 10 technology-powered insurance startups presented their ideas for enhanced customer engagement, cyber security, digital health, smart home products and supply chain management at the first annual Demo Day sponsored by Hartford InsurTech Hub last …

POSTED APRIL 23, 2018 6:00 AM
U.S., Europe Order Emergency Checks on 700 Engines Like One in Southwest Accident
U.S. and European airline regulators on Friday ordered emergency inspections within 20 days of nearly 700 aircraft engines similar to the one involved in a fatal Southwest Airlines engine blowout last week, citing risks of a similar mishap. The directives …

POSTED APRIL 23, 2018 1:44 AM
Australia Looks to Heavy Fines to Punish Financial Services Wrongdoing
Australia’s competition watchdog on Monday supported massive increases in financial penalties for companies caught doing the wrong thing, after widespread misconduct was exposed by an ongoing inquiry into the financial sector. Australian Competition and Consumer Commission (ACCC) Chairman Rod Sims …

POSTED APRIL 23, 2018 1:00 AM
Facebook to Restrict Number of Users Protected Under EU’s New Privacy Law: Reuters
If a new European law restricting what companies can do with people’s online data went into effect tomorrow, almost 1.9 billion Facebook Inc. users around the world would be protected by it. The online social network is making changes that …

POSTED APRIL 23, 2018 1:00 AM
Wells Fargo to Pay $1 Billion Fine for Mortgage, Insurance Sales Abuses
Wells Fargo & Co. will pay $1 billion to settle with U.S. regulators who say the bank wrongly layered insurance on hundreds of thousands of drivers and routinely hit homebuyers with excessive fees, officials said on Friday. The penalty was …

POSTED APRIL 23, 2018 1:00 AM
Blackstone Wants to Manage More Insurance Money
Bets on Spanish housing and oil assets helped Blackstone Group LP mitigate stock market jitters that weighed on it in the first quarter, with earnings at the world’s largest manager of alternative assets falling less than expected. Profits have soared …

POSTED APRIL 23, 2018 1:00 AM

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