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  3. Understanding Health Insurance

Understanding Health Insurance

You have to start somewhere. Let's break down the essentials of getting yourself insured.

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What is the Affordable Care Act?

The Affordable Care Act (ACA) — sometimes called Obamacare — is the health care reform law that makes health plans available to people who are looking to buy their own health plan.

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Coverage options when you’re uninsured

If you don’t have, or lose, coverage through your employer, you have a few different options for staying insured.

  • Illustration of a medical red cross symbol hovering over an outstretched hand- Highmark ACA plans

    ACA

    Quality, affordable individual and family plans that cover preexisting conditions, the 10 Essential Health Benefits, and more.
  • Blue teddy bear illustration representing CHIP Highmark health insurance for children and teens

    CHIP

    Health coverage for uninsured children and teens under age 19. CHIP plans can be low-cost or free depending on household income.
  • Calendar illustration with a date circled showing the limited time to get COBRA Highmark insurance after losing a job

    COBRA

    COBRA is a federal program that allows you to extend employer benefits for a limited time after you lose your job.
affordable care act in text

Affordable Care Act (ACA) basics

Learn more about how the ACA works.

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Understanding insurance networks

What are the main differences between these types of provider networks?

PPO
EPO
HMO
PCP Required

No

No

Yes
Out-of-Network Coverage

Yes, at a higher cost

For medical emergencies only

For medical emergencies only
Referrals needed

No

No

Often, not always

Frequently asked questions

  • Any U.S. citizen, U.S. national, or otherwise lawfully present in the U.S.*
  • Individuals not currently incarcerated.
  • Individuals not enrolled in a Medicare plan.

 

* Only a requirement for purchasing plans on the marketplace. There is no citizenship requirement for purchasing plans directly though Highmark or other health insurance companies.

  • If you experience a major life event, you may qualify for a Special Enrollment Period to sign up for an individual or family plan
  • Examples of qualifying life events: loss of employer-based coverage, birth of a child, move to a new ZIP code
  • A Special Enrollment Period is your only opportunity to enroll in an individual or family plan outside of the annual Open Enrollment Period

You can purchase individual or family ACA plans via:

  • Online marketplaces, also known as federal or state government exchanges. If you’re eligible for financial help, these plans can help lower your monthly premiums and out-of-pocket costs.
  • Direct from Highmark. These plans don’t offer financial help, but you will find some additional plan options here.
  • The annual Open Enrollment Period starts on November 1 in PA, DE, and WV and November 16 in NY. The end date varies by state.
    • PA, DE, and WV: January 15
    • NY: January 31
  • For coverage that begins on January 1, regardless of state, enroll by December 15.
  • Special Enrollment Periods last for 60 days from the qualifying life event.
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Common terms

If you're confused by health insurance terms, you're not alone. There are five common terms you need to know.

 

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Let us help

Highmark representatives are ready to assist you,

Monday – Friday, 9 a.m. – 7 p.m., and Saturday, 9 a.m. – 2 p.m.

call (855) 865-4325

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