THE INFORMATION STATION
MEDICAID
MEDICARE
COMMERCIAL INSURANCE
DENTAL
VISION
BEHAVIORAL HEALTH
LONG TERM CARE
HEALTH INSURANCE
How do I change my health insurance?
Outside the yearly Open Enrollment Period, you can get or change coverage only if you qualify for a Special Enrollment Period or for Medicaid or CHIP. More details can be found at https://www.healthcare.gov/screener/
How do I qualify for a special enrollment period?
Please refer to the link: https://www.healthcare.gov/screener/
Do I qualify for CHIP?
Please refer to the link: https://www.healthcare.gov/screener/
Do I qualify for MEDICAID?
Please refer to the link: https://www.healthcare.gov/screener/
What do you do if your health insurance company doesn’t pay for a specific health care provider or service?
If your health insurance company doesn’t pay for a specific health care provider or service, you have the right to appeal the decision and have it reviewed by an independent third party.
Your insurance company must first notify you in writing within a set amount of time (based on the type of claim you filed) to explain why they denied coverage. They also must let you know how you can appeal their decisions.
If the timeline for the standard appeals process would seriously put your life at risk, or risk your ability to fully function, you also can file an appeal that would get you a quicker (or “expedited”) decision. If you meet the standards for an expedited external review, the final decision about your appeal must come as quickly as your medical condition requires, and no later than 72 hours after your request for external review is received.
If you have questions, contact the Marketplace Call Center at 1-800-318-2596. (TTY: 1-855-889-4325.) or refer to the following link https://www.healthcare.gov/appeal-insurance-company-decision/ .
Helpful Resources & Tools
Overview of using insurance coverage
Please refer to the following link: https://marketplace.cms.gov/technical-assistance-resources/c2c-roadmap.pdf
