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In the News
Interesting articles, trends and stories about the insurance industry
Just recently the TrueCoverage team wrote an article ‘MEDICARE FOR ALL EXPLAINED’ and concluded that while the Democratic party had a distinctly different approach to funding national healthcare from the Republicans, they had yet to find ‘a policy which values enterprise and recognizes that the demand for ANYTHING FREE is infinite.’ In this article, we consider Mike Bloomberg’s stand on ACA and his vision of an affordable healthcare plan.
Whereas Sanders talks of ‘Medicare for all’ Bloomberg’s idea is to introduce an affordable healthcare plan, federally run, as a public option alongside the privately insured ACA. Read about Bernie Sanders take on Medicare for all: Read more
The public insurance option would be aimed initially at the uninsured and low-income families in states which have not expanded Medicaid under ACA.
Mike Bloomberg’s ‘affordable healthcare plan’ can be described as having three objectives. They are to: –
- Extend coverage to those who cannot afford now afford it
- Widen the range of health services
- Reduce/control prices and charges for treatment and medication.
Extend the coverage
The public health insurance (PHI) option would be administered by the federal government (not for profit) but paid for by customer premiums. The same tax reliefs and subsidies would apply as for plans bought on the health insurance exchanges. Individuals would be allowed to keep their private insurances.
At the same time some of Bloomberg’s ‘health care price capping’ and ‘cost control’ initiatives would make ACA compliant plans more affordable and increase the uptake of private health insurance. Currently, approximately 28 million Americans do not have health insurance and a further 41 million are thought to be under-insured.
Some counties do not have full (or any) health insurance coverage. Mike Bloomberg’s stand on ACA would remove this injustice by bringing PHI to the market place.
Widen the range of services
Approximately 30% of US citizens do not visit their dentist regularly, nor do they seek preventative care for hearing and vision. Bloomberg intends to include these as Medicare options and for all states to include oral health services for all adults in the ‘Medicaid’ program.
Reduce/control prices and charges
It is generally agreed that the cost of providing healthcare in the USA is too high (nearly 2x that of other developed countries). The evidence suggests that in many areas (for instance, life expectancy and infant mortality) the outcomes are worse than in other advanced nations.
Extending coverage and widening the range of services are not, in themselves, going to reduce the cost of treatment and care. They should, of course, improve overall outcomes, e.g. life expectancy and infant mortality.
Bloomberg’s approach is to ‘cap’ individual’s premiums to 8.5% of household income. This may be good news to us as individuals but will make additional demands on federal taxes.
He proposes various other caps. For example, on out-of-network charges and most significantly, on the price of medications including prescription drugs. Bloomberg’s affordable healthcare plan would restrict US drug prices to 120% of the average price charged in other advanced nations. To illustrate the problem, some prescription drugs are available in Canada for approximately 30% of the cost of the same drug in the USA. This may be good news for the US citizen with a chronic need but could have a huge revenue/profit impact on major US pharmaceutical companies.
The main influence on our choice of drugs is the pharmacist who fills our prescription. Bloomberg proposes to ban payments to pharmacists by drug companies seeking to obtain preferential treatment. No one should be incentivized to persuade us to buy a branded drug when the generic alternative is just as effective.
As we describe, Bloomberg offers a range of ideas to promote competition and efficiency while maintaining the ethical standards of Medicare, Medicaid and the ACA.
One further idea is to create a permanent reinsurance program. This is common practice in most areas of insurance. It encourages insurers to insure themselves, i.e. spread their risk of having to meet extreme claims. This would enable them to reduce premiums to their clients: Bloomberg claims by 10%.
Bloomberg vs Trump
No one seriously argues that the US health care system is either more efficient or more effective in terms of outcomes than health care systems in other advanced countries.
- The US spends 17-18% of its GDP on health care while the average developed country spend is 8-9%.
- Access to care, the US score lower than other developed countries on the following measures: –
- Practicing doctors -19% per person
- Practicing nurses -25% ~
- Acute beds -26% ~
- In the US 10% of all Americans have no Health Insurance coverage compared with 99-100% coverage in the ten other countries in a recent JAMA study.
Donald Trump takes a laissez faire approach, reckoning that market forces will eventually determine a health care system where demand is met at an affordable price without the intervention of the federal government and minimal involvement of individual states.
The single payer system proposed by Sanders is entirely at odds with Republican ideology and is indeed not widely endorsed by his own party. It would involve the complete dismemberment of existing structures.
In broad terms we devote some $3.5 trillion on the US health care system ($ spent either directly by us as individuals or indirectly through federal and state taxes). About 16 million people are employed within the system and millions more in supporting industries, such as pharmaceuticals and insurance.
Bloomberg’s proposals deserve consideration for their recognition of the multi-dimensional nature of the problems health care faces and the need to build on existing structures for the benefit of the whole nation.
What are the risks of long term opioid treatment?
Medicare Part A/Part B or Part C Advantage with Drugs coverage or Medicare Part D drugs coverage ensure that prescribed pain management care while part of a medical procedure is included in your plan.
Among the drugs available to you on prescription as part of your pain management treatment, and covered by your health insurance plan, will be a group of drugs categorized as opioids.
Sooner or later any of us could face the need for pain deadening treatment. It is important to understand the dilemma that opioids present.
All opioids come with a Doctor’s warning and all medications come with the financial impact of co-pays, co-insurances and out of pocket limits. Most health insurance plans have annual or lifetime limits which include ‘pain relievers’.
If you are reading this article it is probable that you are concerned, either for yourself or for a loved one, about the impact that opioid dependency is having. ACA compliant health insurance plans, Medicare Advantage plans, and Medicare Part D will help with the financial implications but will not resolve the long term inter-personal issues.
Pain management care
Let us be clear, Opioids are very good at what they are prescribed for i.e. pain relief. They are also highly addictive.
There are alternatives!
But first, we consider the risks of opioid treatment.
In fact, the longer you take an opioid medication the greater the risk of addiction. For just this reason, first prescriptions have been limited to 7 days’ supply (since 2019). The evidence suggests that 20% of patients are at an increased risk of opioid addiction after as few as ten days of use. So rapidly can a relief become a dependency?
Of course, opioids are a valid source of pain relief especially for acute pain i.e. pain caused by trauma or surgery. These are pains which diminish or disappear with recovery (typically 3-7 days). It[d1] is important to cease medication as soon as the pain is manageable or to discuss the alternatives with your physician.
One of the recurring examples of acute pain is associated with dental treatment, an extraction for example. An opioid is often the most effective painkiller and dental surgery often the first introduction to their addictive effects.
What is addiction?
Addiction is the third stage of an individual’s response to the extended use of a drug(s).
The first stage is ‘tolerance’. An individual’s response to a drug changes over time and in general, even after a few days, a higher dosage is required to achieve the same effect.
The second stage is ‘dependence’. Opioids in particular, stimulate the excess production of dopamine, the ‘reward’ hormone. As the brain adjusts it requires more opioid to feel the same effect, commonly experienced as euphoria. Dependence is when the individual requires the drug, not necessarily to relieve pain but in order to feel ‘normal’.
The third stage ‘addiction’ is when an individual continues to use the drug despite knowing the harmful consequences, whether on their health, social engagement or financial situation.
Read more about OPIOID Crisis and Addiction
What is an Opioid?
An opioid is a strong pain deadening medicine either produced naturally from the opium found in poppies or artificially using the same chemical structure.
Opioids act by limiting the ‘pain signals’ from the pain ‘site’ to the brain. This is, of course, the beneficial intention of the medication. There are, however, significant side effects. Opioids can cause slowed breathing, confusion, and euphoria (the feeling of reward often described as feeling ‘a little high’) and it is this that makes it easy to want ‘more’.
Common prescription opioids
There others, and it is wise to consult your doctor but you can check on-line if your medication contains an opioid.
Pain management treatment options
- ask your doctor about non-opioid pain relievers. The first step is to reduce the dependence on opioids, preferably to zero
- Exercise and Nutrition
- Specific exercises can increase your range of motion and help to stretch and strengthen muscles
- Eating fresh foods, avoiding caffeine, and following an anti-inflammatory diet can reduce the side effects of reducing opioid dependency.
It may also take a little bit of experimenting to discover which options work best for your individual needs.
However, before beginning an exercise program you should always consult your doctor or qualified physiotherapist. Specific exercises that may help you should be appropriate to your personal circumstances.
Making dietary changes related to the type of pain you experience may help you manage some of your symptoms. There may be very specific instructions for your condition (such as eating a gluten-free diet to manage pain associated with celiac disease).
Finally, Many of the major health insurers have programs to assist opioid dependent clients and others seeking chronic (long-term) pain relief. E.g. Pain management clinics.
If you or someone you care for is seeking advice/support they should contact their healthcare plan provider. If your provider does not have a suitable program e.g. a pain management clinic, contact your Health Insurance Exchange. They can direct you to the providers best able to meet your pain management treatment needs. Even if you switch to a 5* plan this will almost certainly be a good investment.
‘Health care as a human right’ is a key plank in Bernie Sanders 2020 campaign for the nomination as Democratic candidate for the presidency of the USA in the fall.
If he were to win his way to the White House, we can expect Bernie Sanders’ proposal ‘MEDICARE FOR ALL’ to be his flagship program.
So, first, what is ‘Medicare for all’ and why should we need it?
Medicare is a federal health insurance program for US citizens from the age of 65 and is funded from taxation (personal and corporate) and payroll deductions. Low-income families are covered by the federal and state programs Medicaid and the Child Health Insurance Program (CHIP). For more detail see Medicare.gov. Read about Medicare Advantage Plans 2020 in our blog.
From age 26–65 all US citizens are obliged to have a health insurance plan that meets the minimum requirements of the Affordable Care Act (ACA). These are ‘private plans’ and maybe individual, family or group (normally employer-sponsored).
These are the programs that Bernie Sanders is seeking to replace with a single umbrella program embracing the elements Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D in a single all-embracing program, ‘MEDICARE FOR ALL’.
Some of his rivals for the presidential candidacy want to continue the personal choice offered by Medicare Advantage plans.
WHY is Bernie Sanders’ campaign 2020 so focused on Medicare for All?
Primarily because ‘Health’, whichever side of the fence you are on, it is a fundamental concern for all Americans (95% say Medicare is important to the country as a whole) and because it is a clear ‘single-issue’ which distinguishes the left from the right in the House of Congress and in the Senate.
What is it about the existing system that so concerns Bernie Sanders? He cites: –
- The effect on those sections of the population least able to insulate themselves from the financial impact of medical or care expenses
- The high cost of administrating an over-complex system of service provision and cost allocation
- The disproportionately high cost of medical treatment, medications (including prescription drugs) and care
- The ‘excess’ profits made by the big pharmaceutical companies
His evidence: –
Under the existing system, there are approximately 28.5 million Americans who have no insurance coverage (U.S. Census Bureau).
It seems probable that up to 41 million Americans are underinsured and do not have health insurance coverage to meet the cost of traumatic medical treatment or long-term medication.
Over 60% of bankruptcies, (more than 500,000 families) are attributable in whole or in part to medical problems (American Journal of Public Health).
Some facts about Healthcare status in USA: –
In 2016, the health expenditure per capita in the US was $9,870 (W0rld Health Organization, WHO). In the same report, the equivalent figures for Canada were $4,453 and the UK $3,958.
In the same year, 2016, the US spent 17.7% of Gross Domestic Product (GDP) on Healthcare (WHO). The equivalent figures for Canada were 10.53% and UK 9.76%.
One contributor to these extreme differences is the usage of prescription drugs. The US spends over 1.5 to 3 times as much on prescription drug costs as other developed countries, (Journal of the American Medical Association, JAMA). Read more about Prescription Drugs Plan Enrollment Medicare (Part D)
Another is the complex administration required to ensure that millions of health insurance claims are correctly processed and payments made to thousands of providers. Administrative overheads are estimated to absorb 8% of the total healthcare budget. The developed country average is about 2%.
Although he has long campaigned for a ‘single-payer’ national health insurance program to provide everyone in America (sic) with comprehensive healthcare coverage free at the point of service (Health Care as a Human Right, Bernie Sanders 2020) Bernie Sanders 2020 campaign has adopted the less contentious catch-phrase ‘Medicare for all’.
He goes on to say
- No networks, premiums, deductibles, co-pays, no surprise bills
- Medicare will be expanded to include: dental, vision, and home and community-based long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, prescription drugs and more
- Stop the pharmaceutical industry from ‘ripping off ’ the American people by making sure that no one in America (sic) pays over $200 a year for the medicine they need by capping what Americans pay for prescription drugs under ‘Medicare for All’.
How much would ‘Medicare for all’ plans cost’
Let’s start with the current cost. There is a common agreement that the current government contribution to Medicare, Medicaid, and other health insurance programs is in the region of $1.3-1.4 trillion.
Estimates for the ‘Medicare for all’ plan cost and the premises on which they are based vary. Sanders himself (drawing on) Friedman (University of Massachusetts) claims the additional cost would be $1.3 billion. At the other extreme, a 2016 report from the Urban Institute suggests that the annual additional cost of the Medicare for all program might amount to $3.2 trillion.
There is no doubting the Democratic party’s resolve to obtain the most favorable outcomes from the nation’s investment both public and private, in the healthcare of its population. To convince their constituents, they must have a policy that values enterprise and recognizes that the demand for anything ‘FREE’ is infinite.
What is formulary? How do they affect me? What happens if they change?
Read all about Medicare Part D Formulary 2020 in this article.
What are the formularies?
In the context of Medicare drug plans (e.g. Prescription Drug plans, Medicare Advantage plans with drug coverage) the term Formulary refers to the list of drugs covered by a particular plan. Each plan has its own formulary. Plans include both branded and generic prescription drugs.
Who determines the Medicare Part D Formularies?
‘Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare.
Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies’ [drawn from Medicare].
The medications (prescription drugs) on your plan’s formulary are chosen by a panel of experts, the pharmacy and therapeutics committee (P&T) who are independent of the insurance companies.
How do formularies affect me?
It is tempting to think that your Medicare prescription drugs plan or Medicare Advantage prescription drugs plan will cover all your prescription drugs. It won’t!
Many health insurance companies freely publish their formulary. The Silverscript Formulary 2020 and the Humana Formulary 2020 are representative examples. So too are the Cigna formulary 2020 and Aetna formulary 2020, but these insurance companies may not cover your State or county, or may not have a network of pharmacies that fits your circumstances.
You also need to be aware that tax benefits, i.e. the premium tax relief and state-aided benefits, are only available if you purchase your plan through a health insurance exchange, whether Federal, State or Private.
To take the fullest advantage of your plan coverage, you must select a plan (and formulary) that matches your expected usage of prescription drugs and make sure that you can fill your prescriptions at a network pharmacy.
If your prescription drug is not on your plan’s formulary you may have to pay the full price. [If your doctor or other authorized prescriber believes that none of the drugs on your plan’s formulary will be effective you may ask your insurer for an EXCEPTION.]
We referred earlier to ‘tiers’.
What are formulary ‘Tiers’ and how do they affect me?
Let’s be clear: all the drugs covered by your plan must meet the requirements of the MMC and FDA.
In particular, Generic or Multi-Source drugs must demonstrate that they are clinically as effective as the branded equivalent. There may, of course, be a significant price difference. Both you and your insurers have an interest in keeping the expenditure on drugs as manageable as possible without affecting your course of treatment. Hence the need for formularies or lists of approved medications (prescription drugs) which your plan will (help to) cover. When you have met your deductible you will not have to pay full price for further prescriptions during the plan period.
Now about the formulary tiers!
Your physician (or another qualified prescriber) will recommend a particular drug(s) according to your clinical needs.
Generally, these drugs are included in most insurers’ formularies and usually in more than one version. There may be one or more branded versions and one or more generic versions. All of these must meet the standards of the MMC and FDA.
There can be up to five tiers but typically insurers divide their formulary drugs into four tiers: –
There may be some minor differences in the formulation of these medications BUT the major discernable difference will be the COST.
- Tier 1 of Formulary: Low cost generic drugs-Co-pay $20
- Tier 2 of Formulary: Higher cost generic drugs low cost branded drugs – Co-pay $4o
- Tier 3 of Formulary : Brand name drug with no generic alternative – Co-pay $60
- Tier 4 of Formulary: High cost/specialty drugs – Co-pay $100+
With some exceptions prescriptions are filled for a one month supply. You can see that your choice of drug tier will make a huge difference to your monthly outgoings.
When choosing your insurer, make sure there are in-network ‘providers’, authorized prescribers and pharmacies, who are easily accessible, or alternatively that you can receive your medications by direct mail at the ‘in-network’ cost.
There are two further considerations.
- Prior Authorization – Certain drugs require you or your doctor to obtain prior authorization from the insurer in order to be covered
- Step Therapy – Before being covered for a new or expensive drug you must first try a lower-priced (lower tier) drug for the same indication.
What happens if the formulary changes?
If a ‘covered’ drug which you have been taking is removed from your insurer’s formulary you will be given written notice. As a Medicare beneficiary, you can expect a further 60 days supply, giving you time to find an alternative.
You can be sure that drugs will not be withdrawn unless there is a more effective replacement Silverscript formulary 2020 or the same outcome can be obtained more affordably.
Talk to our insurance agent to know more about Medicare Part D Formulary 2020
In this article, we will answer these three questions but only you can take the necessary action.
The Background of Medicare
The essential aim of Medicare is to spread the cost of healthcare, especially in later life (65+), across the lifetime of the individual, the population as a whole through taxation, and by payment, according to the services demanded. Depending on your state you may receive subsidies or free access to some essential services.
We can’t do much about taxes, whether payroll or income but we can choose our personal approach to paying for the services and medication that we need that are not covered by Medicare (Parts A&B).
The Donut Hole – What is it?
Medicare Part D defines and underwrites the medications and drugs which may be prescribed under the act.
The act also defines the annual financial spending limits for each individual.
The largest and fastest-growing element of healthcare costs is Prescription Drug coverage.
To understand the Donut Hole, you have to look at your (anticipated) annual expenditure on ‘prescription drugs and medication’
There are 4 elements,
- ‘The Deductible element’. The amount you pay before your insurance starts to contribute
- ‘The initial coverage element’. Your share with your insurers of the amount spent on prescription drugs. Your choice of plan will determine the balance between co-pays and co-insurance.
The limit of the initial coverage, for 2020 is $4020.
- This ($4020) defines the ‘donut hole’. You would be responsible for 25% (2020) of all your prescription drugs and medication costs up an out of pocket expense limit of $6350.
- If you (0r one of your dependents) exceed the limit, you can plan on a significantly lower copayment or co-insurance for the remaining plan period. The catastrophic element.
What Does This Mean To Me?
The first two elements are a matter of judgment. You can choose the (Medicare-approved) plan (plans) which best meets your anticipated prescription drugs need. Check your historic prescription drug usage and consult your doctor if you anticipate changes in the foreseeable future. Remember the $4020 limit refers to the amount that you and your insurer pay for your prescriptions including your deductibles. Your monthly premium payments do not count towards your initial coverage limit.
In 2020 if you ‘spend’ more than $335 per month on prescription drugs you will reach the ‘donut hole’!
For 2020 the dreaded donut hole is not as significant as it has been in the past. But you should be aware that if your expenditure on prescription drugs exceeds $4,020 you will be responsible for 25% of your expenditure on prescription drugs. Of course, you can choose between generic or brand name drugs.
- You will pay 25% of the retail price
- The amount you pay (25%) will count towards your total drugs spend (TrOOP)
- You will pay 25% of the retail price You will receive a 70% discount from the manufacturer and a 5% contribution from MedicareThe amount you pay (25%) + the manufacturers discount (70%) will count towards your total drugs spend
Note: Branded drugs may be up to 3x more expensive. You should review with your doctor whether there are multi-source (generic) drugs that would be as effective as the branded equivalent.
- The ‘donut hole’ continues to exist as an element in Medicare insurance plans to ensure that MMC has a band of flexibility to meet future contingencies.
For example, the TrOOP limits, and/or the manufacturer discounts may change
For 2020 the upper limit is $6,350 out of pocket expense (TrOOP) which means that the face value of your prescription drugs would be approximately $25,000 in one year.
In practice, only a small proportion of the population reaches these limits. These exceptional circumstances are covered by ‘the catastrophic element’.
IF you or one of your dependents enter the catastrophic coverage stage of your Medicare Plan D your choices are relatively straightforward.
Generic or multi-source drugs
- $3.60 or 5% of retail whichever is greater
- $8.95 or 5% of retail whichever is greater
Remember, your Medicare plan is an annual plan and coverage begins again on January 1st.
Can I Avoid The Donut Hole?
Don’t tempt fate. The only way to avoid the ‘donut’ is by not reaching the individual coverage limit of $4,020.
The question is really,
“How can I make the most of the amount I on spend on prescription drugs?”
Here are some tips: –
- Generic alternatives are available for most branded drugs. They are almost always less expensive their branded equivalent.
- Generic drugs are required by the FDA to have the same essential ingredients as the brand-name equivalent
- To be administered in the same way and at the same dosage
- To be proven to have the same effect
Not all drugs can be prescribed in large quantities. For those that can,
- Order in advance by mail (check first with your insurer)
- Order a ninety-day supply (some pharmacies will give you similar terms)
If there is no generic alternative check on-line. Some manufacturers will supply direct, at a discount.
Check to see if there is a Medicare (Extra Help) program that can help with Medicare Part D costs.
Finally, Take the opportunity to consider alternative plans. Most exchanges can offer plans for you to compare.
TrueCoverage offers the widest selection and puts customized plans at your fingertips in moments.
Invest a few minutes now, you could avoid the Donut Hole and save $ thousands. Make your insurance plans work for you!
Did you check the Medicare star rating?
If you are already enrolled in a Medicare plan you can sit back and relax! Or should you?
Your insurer will already have advised you that your plan needed renewing by December 15th and, in many cases, will have re-enrolled you on the same or similar plan. Your first reaction was probably a relief. One less thing to worry about! But did you check the Medicare Star Rating?
You may be missing an opportunity
Between January 1st and March 31st, you have the opportunity to change your Medicare-approved plan, whatever the star rating, to an alternative Medicare 5-Star plan. You may not be able to reduce your service level (e.g. from silver to bronze) but you will be free to consider the opportunity to switch to another insurer, and/or to a 5-star rated Medicare Advantage plan or to a Medicare Prescription Drug Plan.
Medicare Star Rating
What does the Medicare Star Rating tell us?
Like most five-star Quality Rating Systems (QRS) the overall rating (5 star is best) reflects the performance in key areas of the service being delivered.
In this case
- Medical care
- Member experience
- Plan Administration
If the plan includes prescription drug benefits
- Accuracy of pricing information and patient safety
The Quality Rating System (QRS) will provide you with easily understood information to compare the quality and overall performance of comparable health care plans available on exchange websites. The ratings give you a common platform on which to judge competing plans.
For further information on QRS, the 5-Star ratings, read the TrueCoverage article:-
The most frequently asked FAQ is: what happens if my needs change during the plan period?
Generally speaking, you will have to wait for Open Enrollment, (October 15th – December 7th every year) before you can change your plan or insurer unless you qualify for a Special Enrollment Period.
Usually, there will be a delay between your need to change and when you can alter your plan or take out supplements. This can be life affectingly expensive – unexpected medical treatment, hospitalization, extended prescription drug needs.
Five Star Plans provide the opportunity to change your plan at almost any time (December 8th – November 30th). Of course, there are some limitations. You may only switch plans once during the plan’s life (annual) and between 5 star plans at the same or higher level.
That said, the QRS enables you to select a 5 star plan which meets your needs at an equivalent or lower premium than other less highly rated plans. The security of being able to switch as necessary is a bonus.
Don’t miss the opportunity to switch to a 5 star plan. If you do nothing else, log in to the TrueCoverage web site to check your options. There will plans on your screen for you to compare, within moments! If you need to need to talk to one of our specialists, just enter your contact number. During the working day we will ring back within 30 seconds. Out of hours? We will call you during the first hour of the next working day.
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This website is operated by TrueCoverage and is not the Health Insurance MarketplaceSM website. In offering this website, TrueCoverage is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220 (c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans (QHPs) being offered in your state through the Health Insurance MarketplaceSM website. To see all available data on QHP options in your state, go to the Health Insurance MarketplaceSM website at HealthCare.gov.
Also, you should visit the Health Insurance MarketplaceSM website at HealthCare.gov if:
- You want to select a catastrophic health plan.
- You want to enroll members of your household in separate QHPs.
- The plans offered here don’t offer pediatric dental coverage and you want to choose a QHP that covers pediatric dental services or a separate dental plan with pediatric coverage. Pediatric dental services are an essential health benefit.
TrueCoverage offers the opportunity to enroll in either QHPs and off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.
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