Enrollment Assistance

Health Insurance Marketplace Enrollment Assistance

Patient Navigation & Enrollment Services Department
717-845-8617, option 6

Subsidy CalculatorThis tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance marketplace created by the Affordable Care Act (ACA). With this calculator, you can enter different income levels, ages, and family sizes to get an estimate of your eligibility for subsidies and how much you could spend on health insurance. As premiums and eligibility requirements may vary, contact your Family First Health with enrollment questions.

What is the Health Insurance Marketplace?
The Marketplace is a way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and enroll.

Will I qualify for lower out-of-pocket costs?
When you get coverage through the Marketplace, you may be able to get lower costs on deductible, co-payments and coinsurance. This will depend on your income.

Do I qualify for Medicaid?
You qualify for Medicaid based on income and family size. If you’re eligible, you get free or low-cost care and don’t need to buy a Marketplace plan.

Are my children eligible for CHIP?
If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). If they qualify, you won’t need to buy a Marketplace plan to cover them.

CHIP Basics:
CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers parents and pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program.

What CHIP covers:
The benefits covered through CHIP are different in each state, but all states provide comprehensive coverage, including:

  • Routine check-ups
  • Immunizations
  • Doctor Visits
  • Prescriptions
  • Dental and Vision care
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services
  • Emergency services

States may choose to provide additional CHIP benefits. Check with your state for more information about covered services.

What CHIP costs:
Routine “well child” doctor and dental visits are provided free of charge. But there may be copayments for certain other services. Some states charge a monthly premium for coverage. The costs you’ll have to pay are different in each state, but you can’t be asked to pay more than 5% of your family’s income for the year.

See if your children quality for CHIP
Each state program has its own rules about who qualifies for CHIP. There are  2 ways to see if your children qualify:

  • Visit www.insurekidsnow.gov, or call 1-877-543-7669
  • Fill out the Marketplace application when enrollment opens. When you finish this application, we’ll tell you which programs you and your family qualify for. If it looks like anyone is eligible for CHIP, we’ll let the CHIP agency know so that your coverage can start right away.

Pennsylvania CHIP covers uninsured children in families with moderate incomes that are too high to qualify for Medicaid. You can find out whether your children qualify for Pennsylvania CHIP right now.

What if my children are eligible for CHIP, but I would rather buy a Marketplace plan?
If your children are eligible for CHIP, they would not be eligible for any costs breaks on Marketplace insurance. It would likely be more affordable to cover your children through CHIP. Remember, you and other family members may be eligible for savings on Marketplace coverage.

If my children can get CHIP, but I don’t qualify for Medicaid, how can I get insured?
You may be able to get coverage through the Health Insurance Marketplace and get lower costs on your monthly premiums or out-of-pocket costs. We’ll tell you which programs you and your family qualify for, including private insurance and any cost savings. You can apply even if some family members already have health coverage.

What are my health coverage options if I’m unemployed?
If you’re unemployed, you may qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or lower costs on the Health Insurance Marketplace insurance based on your income.

Your options depend on your household income.

Your household size and income, not your employment status, will determine what health coverage options you’re eligible for and how much help you get paying for coverage. When you apply for Marketplace coverage, you will report your current income and estimate your income for 2015.

Your health coverage options

Based on your income, you may qualify for any of the following:

Medicaid – Medicaid provides coverage to millions of Americans with limited incomes or disabilities. Each state’s Medicaid rules are different. You can apply for Medicaid now to see if you’re eligible. Or you can fill out a Health Insurance Marketplace application when open enrollment begins.

Children’s Health Insurance Program (CHIP) – CHIP provides coverage for children, and in some states pregnant women, in families with incomes too high for Medicaid but too low to afford private insurance. You can apply for CHIP right now to find out if you’re eligible. Or you can fill out a Marketplace application when open enrollment begins.

Lower costs on Marketplace insurance – You may qualify for lower costs for monthly premiums and out-of-pocket costs on private insurance based on your household size and income. Some people with very low incomes may wind up paying very small premium – or no premiums at all.