A comprehensive resource for information regarding healthcare coverage

Frequently Asked Questions

Can I get dental care in the Marketplace?

In the Health Insurance Marketplace, you generally can get dental coverage as part of a health plan or by itself through a separate, stand –alone dental plan.

https://www.healthcare.gov/can-i-get-dental-coverage-in-the-marketplace/

What does Marketplace health insurance cover?

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits which include at least the following:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services
What if I’m a part-time / seasonal employee without Health Coverage?
If you are a part-time worker without job-based coverage, you may be able to buy health insurance in the Marketplace and get lower costs based on your household income and family size.
What are my health coverage options if I’m unemployed?
If you’re unemployed you may qualify for Medicaid, CHIP or lower costs on Marketplace insurance based on your 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 your coverage.
What if I have pre-existing health conditions?
Starting in 2014, health insurance plans can’t refuse to cover you (guaranteed issue) or charge you more just because you have a pre-existing health condition. 
What are my preventative care benefits?

There are preventative care benefits for adults, women and children.  For detailed information regarding each benefit please visit the link below:

Learn More
If I am a Utah based Small Company, what are my group health insurance options?
Avenue H offers small Utah based groups access to group insurance plans.  It also offers small business tax credits to those that participate in the Avenue H Marketplace. 
What if I’m pregnant or plan to get pregnant?

If you’re uninsured and pregnant you may be turned down, charged a higher premium, or have benefits excluded until 2014.  Until then Medicaid and CHIP may help.

All Health Insurance Marketplace plans cover pregnancy and childbirth.  If you get a health plan through the Marketplace, coverage for your pregnancy and baby can start as soon as January 1, 2014.  You can apply for coverage right now.

What if someone doesn’t have health coverage?

If someone who can afford health insurance doesn’t have coverage, they may have to pay a fee or penalty.  They also have to pay for all of their healthcare.  The fee is calculated two different ways – as a percentage of your household income, and per person. Your fee will be whichever is the higher of the two.

It is important to remember that someone who pays the fee won’t get any health insurance coverage.  They still will be responsible for 100% of the cost of their medical care.

Why should I have health coverage?

No one plans to get sick or hurt, but most people need medical care at some point.  Health insurance covers these costs and protects you from very high expenses.  Plans available in the Marketplace provide free preventative care like vaccines, screenings, and check-ups.

Do you know the average cost of a 3-day hospital stay is $30,000?  Or that fixing a broken leg can cost up to $7,500?  Having health coverage can help protect you from high, unexpected costs like these.

What is a Premium?
A premium is a fixed amount you pay to your insurance plan, usually every month.  You pay this even if you don’t use medical care that month. 
What is a Deductible?
If you need medical care, a deductible is the amount you pay for care before the insurance company starts to pay its share.  Once you meet your deductible, your insurance company begins to cover some costs of your care.  Some plans have lower deductibles, like $250.  Some have higher deductibles, like $2,000.
What is a Copayment?
A copayment is a fixed amount you’ll pay for medical service before or after you’ve met your deductible, depending on your plan. 
What is Coinsurance?
Coinsurance is similar to copayment, except it’s a percentage of costs you pay.  For instance, you may pay 20% of the cost of a $100 medical bill.  So you would pay $20 and the health plan would pay the rest. 
If I or my spouse have affordable group health insurance can my spouse or kids still go to the Marketplace to get subsidized coverage?
No, if you have affordable group coverage for yourself or through your spouse you nor your kids will be eligible for a subsidy within the Marketplace. 
How do I get an exemption from the fee for not having health coverage?

Starting 2014, most people must have coverage or pay a fee (the “individual shared responsibility payment”).  You can get an exemption in certain cases.

  • You’re uninsured for less than 3 months of the year
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You don’t have to file a tax return because your income is too low
  • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • Certain Hardship exemptions (Contact to learn more)
Where can I get low-cost care in my Utah based community?

If you can’t afford any health plan, you can get low-cost health care at a nearby community health center.  How much you would pay depends on your income.  For more information regarding the local Health Centers please visit the link below:

For more Frequently Asked Questions and Answers please visit the link below:

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