Essential Health Coverage
The Affordable Care Act requires all individuals not covered by minimum essential coverage (such as an employer-sponsored health plan, Medicaid, or Medicare) to secure an individual health insurance policy.
The individual’s policy must meet certain standards or pay a penalty (unless the individual has a financial hardship or is exempt by the Internal Revenue Service). This requirement is sometimes called the “Individual Mandate.”
What are some of the ways to get health insurance?
- Through your employer
- Buy it on the Health Insurance Exchange (explained below)
- Buy it directly from an insurance company, agent, or broker
- You may qualify for other programs such as Medicare or Medicaid
To find out more information about your options, you can visit your state government’s insurance website.
Medicare is a Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD – permanent kidney failure requiring dialysis or a transplant).
If this applies to you and you would like to know more about Medicare options, read more here.
Can I elect coverage under Medicare? Should I?
People who are still working (or have retiree, COBRA, or other types of coverage) have important decisions to make about their health coverage when they become eligible for Medicare. The rules about how other insurances work with Medicare and what people should consider when deciding varies on a case-by-case basis.
For more information about whether and when you can or should enroll in Medicare, visit here.
What is a Health Insurance Exchange?
- Health Insurance Marketplaces (also called health exchanges) are online locations where someone can find and enroll in a health plan to meet minimum essential coverage.
- Marketplaces provide a set of government-regulated and standardized healthcare plans where people can purchase policies that are eligible for Federal subsidies.
- Health plans on government-regulated marketplaces will satisfy your obligations under the ACA’s Individual Mandate.
Where can I find information specific to my state?
If you live outside of PA, NJ, or DE, go to Heathcare.gov to learn how to enroll in the right plan for you.
How do I make sure that my insurance plan will cover treatment at Jefferson Health facilities?
All insurance companies must disclose to their consumers all of the healthcare providers included in each of their insurance plans.
For any plan, review the information concerning in-network providers to ensure that the plan includes:
- Thomas Jefferson University Hospital (including Methodist, Jefferson Hospital for Neuroscience, and all urgent care and outpatient centers)
- Abington Hospital (including Abington – Lansdale Hospital and all urgent care and outpatient centers)
What do the tiers in a healthcare plan mean?
Tiers of an insurance plan represent the varying levels of copayments, coinsurance, deductibles, and out of pocket maximums involved with health coverage depending on which tier of healthcare provider selected.
For example, if a patient is treated at a tier 2 or 3 healthcare provider, the patient’s out-of-pocket cost may be higher than if the patient received treatment at a tier 1 healthcare provider.
Your selections are not just about today.
Tiered insurance products may offer lower premiums up front, but may end up being much more expensive if you require treatment at a specialized facility. When deciding whether to select a tiered product, be sure to take into account your future health; you may not need access to our specialized facilities now, but your health might change and you would want coverage for those future needs.
Why choose Jefferson Health?
Jefferson Health proudly includes premier facilities within the Philadelphia area boasting prestigious distinctions such as MAGNET recognition for Nursing Excellence and being a National Cancer Institute (NCI)-designated Cancer Center. We are leaders in treatment, research, and education as well as possessing Joint Commission Accreditation and are a Level 1 Trauma Center. Read more about Abington - Jefferson Health's proud honors.
What can I do if I was denied coverage or I am unhappy with my insurance?
Your best course of action is to contact your state’s Office of the Insurance Commissioner (OIC) to express concern or anything else about your health insurance. The OIC oversees the insurance industry and protects your interests.
What should I take into account when comparing health insurance?
- Your income
- Your family
- Your current and future health
Schedule an appointment to better assess your current health and help determine future need. Some of the many options available include:
You will also want to take into account…
What are some of the ways I can supplement costs of health care?
For information about potential tax credits, lowering premiums, qualifying for Medicaid, or just general help enrolling, choosing a plan, and deciphering common insurance terms, visit Healthcare.gov .
Where can I compare the cost of popular plans that include Jefferson Health?
Here are just a few of the insurance providers that participate in coverage with Jefferson Health. Feel free to peruse their options and compare the health plans they have available.