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Yes. You may buy a policy for a child through HealthCare.gov. Any health plan offered through the exchange must also be offered as a child-only plan.
You may be eligible for tax credits for child-only plans purchased through HealthCare.gov.
However, children who are not citizens or legal residents of the United States are not eligible for child-only plans through HealthCare.gov. You may be able to buy a child-only policy in the market outside HealthCare.gov, either from an insurance company or through an agent.
No. Undocumented immigrants are not eligible for coverage through Healthcare.gov. However, some individuals may qualify for emergency-only coverage through the Citizen Alien Waived Emergent Medical (CAWEM) program through the Oregon Health Plan. If you think you might qualify for this, visit oregonhealthcare.gov.
A plan is considered unaffordable if the employee's premium costs more than 9.5 percent of the employee’s household income or if it pays for less than 60 percent of covered health care expenses.
In considering whether a plan is affordable, the premium cost for an employee's spouse or children is not taken into account. In other words, the law looks at the cost of employee-only coverage and not a family plan.
If an employer of any size offers affordable coverage and makes it available to dependents, even though the employer may pay little or no part of the costs, family members will not be eligible for subsidies through an exchange.
Call the insurance company or go on its website. Remember, however, that it’s important to find out who is in the network in your area. The company with the largest statewide network might not be the same company that has the most doctors and other providers in your part of the state.
You may still contribute to a health savings account (HSA) that is paired with a high-deductible health plan. In this type of plan, deductibles are higher than in some plans, making premiums lower.
Every small group and individual plan must cover essential health benefits. Even though you may not need every benefit in a plan, plans must cover all of the essential benefits to share risk across a broad pool of consumers.
Health insurers keep lists of what drugs they cover, at what cost. These lists are called formularies. Drug cost-sharing is often tiered. Typically, you pay less for a generic drug, more for a brand-name drug, and sometimes even more for a nonpreferred brand-name drug.
Adult dental coverage: This is not required, but you can buy stand-alone plans.
Children’s dental coverage: Plans sold through HealthCare.gov do not have to include children’s dental benefits because you can buy stand-alone (separate) pediatric dental plans. Outside of the exchange, however, health plans must include pediatric dental benefits unless the insurer is reasonably assured that you purchased pediatric dental coverage certified by the exchange.
Insurers must charge the same amount for the same plan whether it is sold through HealthCare.gov or in the market outside of HealthCare.gov.
Surprise billing happens when a patient receives an unexpected bill after they receive care from an out-of-network provider or at an out-of-network facility, such as a hospital. It can happen regarding both emergency and non-emergency care. Typically, patients don’t know the provider or facility is out-of-network until they receive the bill. The practice that creates the surprise bill is called balance billing.
A federal law, the No Surprises Act, protects you from surprise medical bills when you receive these types of health care services at certain facilities.
If you believe you have been improperly billed under the No Surprises Act, contact the Oregon Division of Financial Regulation to speak with a consumer advocate.
File a complaint online or contact us:
Financial services Email:DFR.FinancialServicesHelp@dcbs.oregon.gov
Securities and investments Email:Securities.Registrations@dcbs.oregon.gov
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