Health Care Reform FAQ – Changes to Other Federal Health Care Programs

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KNOW YOUR BENEFITS: Health Care Reform FAQ – Changes to Other Federal Health Care Programs

If I have Medicare do I need to do anything?

No. Medicare isn’t part of the health insurance marketplace, so you don’t need to do anything.

The Marketplace won’t affect your Medicare choices, and your benefits won’t be changing. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now. You won’t have to make any changes.

The Marketplace does not offer Medicare supplement (Medigap) insurance or Part D drug plans. For information on these programs, visit

If you only have Medicare Part B, you are not considered to have minimum essential coverage. This means you may have to pay the penalty that people who don’t have coverage may have to pay. If you have Medicare Part A only, you are considered covered. If you have both Medicare Part A and Part B, you are also considered covered.

Do I qualify for Medicaid?

You may qualify for free or low-cost care through Medicaid based on income and family size. Some states have expanded Medicaid to cover more people. You can apply for and enroll in Medicaid at any time of year. There’s no limited enrollment period. If you qualify, your coverage can begin immediately.

If you have Medicaid coverage, you’re considered covered and you don’t have to buy a Marketplace plan.

Some states have expanded their Medicaid programs under health care reform, while others have not. Your Medicaid coverage options depend mainly on your state, your income and your household size.

Medicaid programs must follow federal guidelines, but they vary somewhat from state to state. Coverage and cost may be different from state to state. Some Medicaid programs pay for your care directly, while others use private insurance companies to provide Medicaid coverage. Also, some state programs have names that don’t say “Medicaid.” For example, in Oklahoma, it’s called SoonerCare. In Minnesota it’s called Minnesota Care.

In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly and people with disabilities. In some states the program covers all low-income adults below a certain income level. To see if you qualify for Medicaid, visit your state’s Medicaid website. Check with your state’s program to find out what’s covered.

Are my children eligible for the Children’s Health Insurance Program (CHIP)?

It depends. 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.

If your children qualify for CHIP, you won’t need to buy a Marketplace plan to cover them. You can apply for and enroll in CHIP at any time during the year. There’s no limited enrollment period for CHIP. If your children qualify, coverage can begin immediately.

Each state program has its own rules about who qualifies for CHIP. There are two ways to find out whether your children qualify:

  • Visit, or call 1-877-543-7669.
  • Fill out the Marketplace application. When you finish this application, the Marketplace will tell you which programs you and your family qualify for. If it looks like anyone is eligible for CHIP, the Marketplace will notify the CHIP agency so that your coverage can start right away.

What do military veterans need to know about the Marketplace?

If you’re enrolled in (or are a beneficiary of) any of the programs listed below, you’re considered to have minimum essential coverage under the health care law, and you don’t need to get additional coverage.

  • Veterans health care program
  • VA Civilian Health and Medical Program (CHAMPVA)
  • Spina bifida health care benefits program

If you’re a veteran without VA health care, visit the VA health care website at You may learn that you qualify for VA coverage.

If you’re a veteran who is not enrolled in VA benefits or other veterans’ health coverage, you can get coverage through the Marketplace during the annual open enrollment period (or, if you qualify, during a special enrollment period). You may be able to get lower costs on monthly premiums and out-of-pocket costs through the Marketplace, depending on your household size and income. Or, you may qualify for free or low-cost coverage through Medicaid or CHIP.

If you’re a veteran enrolled in (or are a beneficiary of) a VA health care program, your dependents who are not eligible for a VA health care program may use the Marketplace to get coverage.

TRICARE’s young adult coverage option is different from the Affordable Care Act’s under-26 rules. Eligibility ages, benefits and other details differ.

What do American Indians and Alaska Natives need to know about the Marketplace?

If you’re a member of a federally recognized tribe and qualify for a health insurance plan in the Marketplace, you have certain protections, such as the following:

  • Monthly special enrollment periods
  • No copayments or other cost-sharing if your yearly income is below a certain level. When you fill out a Marketplace application, you’ll find out whether you qualify for these lower costs.

Also, if you’re an American Indian or Alaska Native or are otherwise eligible for services from the Indian Health Service, tribal program or urban Indian health program:

  • You have special cost and eligibility rules for Medicaid and CHIP that make it easier to qualify for these programs.
  • If you don’t have health insurance, you won’t have to pay the fee that most other people without health insurance must pay.

If you enroll in a private health insurance plan through the Marketplace, you can get (or keep getting) services from the Indian Health Service, tribal health programs or urban Indian health programs. Also, you can get services from any providers on the Marketplace plan.

Where can I get free or low-cost care in my community?

If you can’t afford any health plan, you can get free or low-cost health and dental care at a nearby community health center.

How much you pay depends on your income. Community health centers are located in both urban and rural areas and provide:

  • Prenatal care
  • Baby shots
  • General primary care
  • Referrals to specialized care for more serious conditions, including mental health, substance abuse and HIV/AIDS

Locate a community health center near you.

For more information, contact Southwest Risk Management today at 1-866-924-7976 (SWRM)


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