if you already have coverage through the marketplace, your marketplace health plan’s rules for emergency treatment of coronavirus disease 2019 (covid-19) remain the same as for any other viral infection, but your health insurance company may have additional benefits.
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- see what the marketplace plans cover. all plans in the marketplace cover treatment for pre-existing medical conditions and cannot cancel coverage due to a change in health status, including covid-19 diagnosis or treatment.
- Check with your health insurance company for your specific benefits and coverage policy.
- log in to update your marketplace application if covid-19 affects your income or household. you may be able to change your plan if certain situations apply.
- Your initial COVID-19 primary vaccines from one of these vaccine series:
- children of 6 months to 4 years: 3 shots
- anyone over 5 years old: 2 injections
- note: if your first injection is pfizer-biontech, your other initial covid-19 primary vaccines must also be pfizer-biontech.
- any 6 months or older: 2 injections
- note: if your first shot is modern, your second shot must also be modern.
- johnson & johnson/janssen
- adults over 18 years of age: 1 injection
- anyone over 12 years old: 2 injections
an additional primary vaccine at least 4 weeks after completing your initial series of primary vaccines against covid-19 if you have immunosuppression, such as people who have had an organ transplant and are at risk for infections and other illnesses. (note: if you received a novavax covid-19 vaccine, an additional primary injection is not recommended at this time).
- if your first two injections were pfizer-biontech, your third injection should also be pfizer-biontech.
- If your first 2 shots were modern, your third shot should be modern too.
- if your first chance was johnson & johnson/janssen, you can get an additional primary injection from pfizer-biontech or modern. Learn more about additional primary immunizations if you have a compromised immune system at cdc.gov.
an updated covid-19 vaccine for people older than 5 years. the updated vaccine targets the original covid-19 viral strain and 2 omicron variants (ba.4/ba.5). You can receive the catch-up vaccine at least 2 months after completing your primary vaccination series from Pfizer-Biontech, Modern, Novavax, or Johnson & johnson, regardless of how many original COVID-19 vaccines he has received so far.
- The updated pfizer-biontech vaccine is available to anyone ages 5 and up.
- The modern up-to-date vaccine is available to anyone 6 years of age and older.
- Check the receipts and statements you receive from your provider for errors.
- Call your provider’s office to ask about any charges you think are incorrect. the person you speak with can help you better understand the services you received or realize you made a billing error.
- Review your “explanation of benefits.” report anything suspicious to your insurer.
- You can purchase up to 8 OTC tests per month for each person on your Marketplace plan. For example, if you have 4 household members on the same plan, you can get 32 tests each month. note: Marketplace plans will only cover over-the-counter covid-19 home tests that have been cleared, cleared, or approved by the fda.
- Your Marketplace plan:
- You’ll pay up front when you buy the test through an in-network provider
- reimburse you for the cost after you submit a claim. If you purchase the test from a provider outside of your plan’s network, your plan will reimburse you up to $12 (or the cost of the test, if it’s less than $12).
- wait in your car until the start of the visit
- use limited input
- perform a covid-19 detection test by checking your temperature
- avoid waiting rooms and areas
- maintain social distancing
- wear a face covering, which will be provided if you do not have your own
- wash your hands or use hand sanitizer
- lost health coverage through your employer in the last 60 days
- lost health coverage through a household member’s employer in the last 60 days
- expects to lose coverage within the next 60 days (for example, if you lose health coverage through a parent or guardian because you are no longer a dependent).
- If your employer reduced the hours you work and you are enrolled in a Marketplace plan: Update your application immediately within 30 days to report any income family changes. you may qualify for more savings than you receive now. Learn how to report changes and estimate your income.
- If you were laid off: In some situations, depending on the status of your employer’s health coverage, you may qualify for a special enrollment period. You may also be eligible for a premium tax credit to help pay for Marketplace coverage. create an account or sign in to launch your marketplace app to find out if you qualify.
- need help estimating your income? use this income calculator to make your best estimate.
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if you qualify for cobra continuation coverage:
- If you are entitled to Cobra continuation coverage after losing your work-based coverage, you may still qualify for a special enrollment period due to loss of coverage. You have 60 days after losing work-based coverage to enroll in Marketplace coverage. You may also qualify for premium tax credits if you cancel your Cobra continuation coverage, or if you didn’t accept it at first.
- if you are enrolled in cobra continuation coverage, you may qualify for a special enrollment period if the costs of your cobra continuation coverage change because your former employer stops contributing, for which you have to pay the full cost , or if you receive assistance paying your premium. for your collect premiums and terminate your premium assistance. learn more about cobra continuation coverage and the marketplace.
If you lost your job, but you didn’t also lose health coverage because your previous job didn’t offer coverage: Generally, you won’t qualify for a special enrollment period. By itself, a job loss (or a change in income) does not make you eligible for a special enrollment period to enroll in Marketplace coverage.
coverage start dates with a special enrollment period due to loss of coverage
- If you’ve already lost coverage, your Marketplace coverage can start the first day of the month after you apply and enroll.
- If you know you will lose coverage within the next 60 days, you can submit a request on healthcare.gov before you actually lose your coverage to help ensure there is not a gap in coverage. coverage. For example, if you know you will lose coverage on August 30, and you apply and enroll in a Marketplace plan on August 10, your new coverage will start on September 1.
- Check with your insurance company about extending your premium payment deadline or ask if they will delay terminating your coverage if you cannot pay your premiums.
- If your household income has changed, update your application right away. you could qualify for more savings than you are receiving now.
- If you are receiving financial assistance for your Marketplace premiums, you have a three-month grace period to catch up on your premium payments and avoid having your coverage canceled for non-payment. Most of the time, if you don’t get financial help with your premiums, you have a grace period determined by state law (usually one month).
- You could qualify for more savings than you receive now. this could lower what you pay in monthly premiums.
- You may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
- Need help estimating your new income? use our income calculator to make your best estimate.
- When your child moves to or from where you live and goes to school, they may be eligible for a special enrollment period that allows them to enroll outside of the annual open enrollment period if:
- You’re still enrolled in a student health plan, but the coverage and benefits don’t extend to your area, or your child’s move means they’ve moved to a new zip code or county.
- had qualifying health coverage or lived in a foreign country or in the us. territory for at least one of the 60 days prior to the date of her removal. Note: This requirement does not apply to members of a federally recognized tribe or shareholders of Alaska Native corporations.
- If your child is under 26 and already enrolled in Marketplace coverage, you may be able to add your child to your plan.
- If you have Marketplace coverage with savings and don’t plan to claim your child as a tax dependent on their federal tax return, your child should set up their own Marketplace account and submit an application separate.
- If you plan to claim your child as a tax dependent on your federal tax return and you currently have Marketplace savings with your coverage, you can update your Marketplace application and add your child.
- If you have Marketplace coverage without applying for savings, you can include them all in one application.
- with limited coverage, you can complete a marketplace application to find out if you qualify for full coverage, including covid-19 testing, through medicaid, chip, or the marketplace with savings based on your income. When you apply, don’t tell us you have Medicaid.
- If you enroll in Marketplace coverage and qualify for help paying for that coverage, please notify your state Medicaid agency of this new coverage.
- Note: If your Medicaid coverage for the COVID-19 test ends outside of the annual open enrollment period, you will not be eligible to enroll in a Marketplace health plan unless you have had other qualifying life event. for a special enrollment period, since limited medicaid does not count as qualifying health coverage.
- your state recently determined that you are not eligible for medicaid or chip.
- is losing or recently lost medicaid.
- Your current coverage is ending.
- special enrollment periods
- medicaid & chip cover
Note: If you change plans or add a new household member, any out-of-pocket costs you already paid in your current 2022 market plan likely won’t count toward your new deductible, even if you You stay with the same insurance company. Call your insurance company before you change plans or add a new household member to find out if you’ll need to start over to meet your new plan’s deductible.
if you have limited medicaid that covers only diagnostic tests for covid-19
In some states, Medicaid may cover COVID-19 testing if you don’t have other health coverage and don’t qualify for full Medicaid or Children’s Health Insurance Program (CHIP) coverage. This limited Medicaid benefit only covers COVID testing and does not cover any other health care benefits and services. does not count as having qualifying health coverage.
when completing your marketplace application, if your only coverage ends with covid-19 testing for medicaid coverage, please do not tell us:
more information about:
for the latest information on covid-19
if you are unable to pay your premiums due to a hardship due to covid-19
if you’re enrolled in a Marketplace plan and your income has changed
If you’re enrolled in a Marketplace plan and your household income has changed, update your application right away. if your income drops or a household member gains:
if your child no longer lives with you after the college sent him home early or due to a change in his college residence
If you plan to claim your child as a tax dependent on your federal tax return and you currently have Marketplace savings with your coverage, you can keep your child on your Marketplace application. Read the plan coverage documents and carefully review the provider network to see how the plan covers care provided in the state where your child attends school.
Call your health plan for details.
if you need medical attention
call before going to the doctor. You may be asked to do the following to reduce the risk of exposure and protect others:
If you are sick with or think you may have COVID-19, visit cdc.gov for steps to help prevent the spread. If you need emergency care, you should go to the nearest hospital that can help you.
if you lost your job or experienced a reduction in hours
You may qualify for a special enrollment period if you experience certain life changes such as:
Note: If you lost coverage or had another life change more than 60 days ago, you may qualify for a Special Enrollment Period if you previously qualified for a Special Enrollment Period, but missed the 60 -day deadline to enroll because it was affected by the covid-19 national emergency. Voluntarily dropping coverage does not qualify you for a special enrollment period unless you also had a decrease in household income or a change in your prior coverage that made you eligible for savings in a Marketplace plan.
Note: Some adults over the age of 18 who have completed their primary vaccine series have the option of receiving a Novavax vaccine instead of the updated Pfizer-Biontech vaccine or the modern COVID-19 vaccine. Visit cdc.gov to learn more about the novavax vaccine.
stay up to date on covid-19 vaccines at cdc.gov.
if you paid to get vaccinated against covid-19
When you receive a COVID-19 vaccine, your provider cannot charge you for an office visit or other fee if the vaccine is the only medical service you receive. If you get other medical services at the same time you get the COVID-19 vaccine, you may have a copayment or deductible for those services.
If you paid a fee or received a bill for a COVID-19 vaccine, check this list to see if your provider should have charged you:
If you think your provider incorrectly charged you for the COVID-19 vaccine, ask for a refund. If you think your provider charged you for an office visit or other fee, but the only service you received was a COVID-19 vaccine, report it to the US Office of the Inspector General. uu. department of health and human services by calling 1-800-hhs-tips or visiting tips.hhs.gov.
covid-19 diagnostic tests
All health plans in the marketplace cover covid-19 diagnostic tests performed at the office of a doctor or other health care provider in your plan’s network, even if you don’t have symptoms or don’t know if you’ve been exposed to covid-19 -19. For example, if you want to make sure you’re COVID-19 negative before visiting a family member, you pay nothing to get tested.
Your marketplace plan covers covid-19 home tests you buy online or at a pharmacy or store.
all plans on the market cover: