Health care for everyone — the Affordable Care Act

This time period is called the “open enrollment period.”

After this period ends (January 31^st), you will not be able to get insurance through the Affordable Care Act.

Please note that while enrollment in Medicaid continued automatically through the Public Health Emergency (PHE) status as a response to the pandemic, this process will end in December. Because of this, it will be necessary to enroll yourself during the open enrollment period above (November 1 2021-January 31, 2022).

If you need help enrolling or would like to talk with someone about what plans you may be eligible for, you can call us at 800-444-1975, choose extension 1.

If you are comfortable enrolling yourself or your family, you can click here to get started.

It’s important to note that many health care providers offer care under the Affordable Care Act—including Sun River Health! Of course, we hope you will stay or join us for care, but it’s important to know that you have choices.

Below is more information on the affordable care act (ACA), also known as “Obamacare”.

Dates for enrollment: November 1 - January 31, 2021

Special Enrollment Period (SEP)

Under some circumstances, you may still be able to get ACA health insurance:

Loss of other health insurance coverage:

• You lost your job or lost coverage through another person’s job.
• You no longer have Medicaid coverage or Children’s Health Insurance Program (CHIP).
• You lost coverage under a parent’s health plan. At the age of 26, individuals may lose coverage and can qualify for SEP.
• You lost coverage due to COVID-19-related reasons

Change in household size:

• You got married (since 2017, this generally applies only if at least one spouse already had coverage before the wedding, although there are some exceptions).
• You had a baby, adopted a baby/child, or placed a child for foster care.
• You gained or became a dependent due to child support or other court order

Change in your primary place of living (in most cases, this only applies if people already had coverage prior to moving) because:

• You moved to a new home (different zip code & county).
• You moved to the U.S. from a foreign country or U.S. territory.
• You moved to or from school, place of seasonal employment, a shelter, or other transitional housing.

Change in eligibility for Marketplace coverage or help paying for coverage:

• You became a U.S. citizen or lawfully present individual.
• You are newly eligible for Marketplace after being released from incarceration (detention, jail, or prison).

What is Medicaid?

A program that provides health coverage to low-income adults, children, pregnant women, elderly adults, and people with disabilities who qualify. Medicaid is administered by states, according to federal requirements.

What is a copay?

Payment made by the patient when getting care from health providers. The patient usually pays a small part, and the insurer pays the rest.

What is a premium?

A premium is how much your health insurance will cost. This amount is usually paid every month by the patient covered.

What is a deductible?

The amount you must pay for services before the health insurance begins to cover your health expenses.

What is a Tax Credit?

Credits provided by the federal government as income tax deductions to help you buy insurance coverage. The credit amount is based on income.

What are Lifetime Limits?

The maximum amount of healthcare costs your insurance will pay for if you get sick.

What is a Sliding fee scale?

The way Federally Qualified Health Centers determine how much a patient should pay for services depends on how much money they make and the number of dependents in their family.

What is Young Adult Coverage?

Children under 26 years old can remain on a parent’s plan even if:

• they are married
• not living with you
• attending school
• not financially dependent on you
• or are eligible to enroll in their employer’s plan