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FAQs

FAQ-Page

a

Skilled nursing facility care

Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Skilled nursing facility

A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Service area

An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Rural emergency hospital

A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Referral

A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Primary care doctor

The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Copayment

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Coinsurance

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page

Click a topic to expand to see all related FAQs.

01 General

a

Skilled nursing facility care

Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Skilled nursing facility

A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Service area

An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Rural emergency hospital

A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Referral

A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Primary care doctor

The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Copayment

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Coinsurance

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page

02 Medicare

a

Skilled nursing facility care

Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Skilled nursing facility

A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Service area

An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Rural emergency hospital

A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Referral

A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Primary care doctor

The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Copayment

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Coinsurance

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page

03 Affordable Care Marketplace

a

Skilled nursing facility care

Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Skilled nursing facility

A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Service area

An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Rural emergency hospital

A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Referral

A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Primary care doctor

The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Copayment

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Coinsurance

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Is there government assistance to help me pay for my health care insurance?

Yes. Known as “subsidies,” there are two forms of government assistance available for those who meet certain income requirements.
 
The first is the Premium Tax Credit. The government will help pay for – subsidize – your monthly insurance rate if your income is at or below 4x the Federal Poverty Line.
 
The second is the Cost Sharing Reduction when the government helps pay for your out-of-pocket costs. To qualify, you must choose a Silver plan. Your income must be at or below 2.5x the Federal Poverty Line. 
Category: 03 Affordable Care Marketplace
a

How is an Affordable Care Plan subsidy calculated?

It is calculated on your current year’s approximated Adjusted Gross Income.

Category: 03 Affordable Care Marketplace
a

Why would I elect to enroll in an Affordable Care Act plan?

There are two main reasons people choose the ACA:  1) These plans cover pre-existing conditions. 2) You can receive a substantial premium subsidy.

Category: 03 Affordable Care Marketplace
a

If I don’t qualify for a premium Affordable Care Act subsidy, can I still get an Affordable Care Act plan?

Yes, anyone can enroll in an Affordable Care Act plan. You can enroll during Open Enrollment  which is November 1st through January 15th. You can also qualify for a Special Enrollment Period outside of Open Enrollment when you have a qualifying life event (For example, marriage, new baby, loss of insurance, etc.) All Affordable Care Act plans are HMO provider networks.

Category: 03 Affordable Care Marketplace

FAQ-Page

a

Skilled nursing facility care

Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Skilled nursing facility

A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Service area

An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Rural emergency hospital

A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Referral

A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Primary care doctor

The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Copayment

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page
a

Coinsurance

An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Source: Medicare and You 2027 Medicare Handbook

Categories: 01 General 02 Medicare 03 Affordable Care Marketplace FAQ-Page

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