Jan. 7, 2015
insurance.” Sounds scary, doesn’t it? But catastrophic insurance is a special
kind of health insurance coverage consumers can purchase on the federal
marketplace. “Hey, Doc” the Texas Medical Association’s education campaign,
insurance and what
it covers in this week’s Q&A.
insurance is meant to be a sort of safety net that covers you when something
like a major accident or serious illness comes up.
It covers only
three regular doctor visits a year and certain preventive care. So your monthly
charge, or premium, might be lower for catastrophic insurance, but you likely
will have to pay higher costs out of your own pocket before full coverage kicks
in for things like essential benefits. And if you buy one of these plans, you
won’t be eligible for any financial assistance to help pay for it.
In the marketplace,
catastrophic plans are mostly available to people under 30 years old; people
who don’t earn much; and people who experience certain hardships, like
homelessness, bankruptcy, or unexpectedly high medical bills.
If you are older
than 30, you might also qualify temporarily to buy catastrophic insurance if
you have an old policy that was canceled for not meeting the new ACA standard,
and you can’t afford anything else.
covered by this insurance?
All plans in the
marketplace have to offer what’s called “essential
health benefits.” This is a basic package covering 10 different categories:
- Doctor visits;
- Hospital visits;
- Prescription drugs;
- Lab tests;
- Emergency room visits;
- Care when you are pregnant and when you have your
- Care for children;
- Preventive services that help you stay healthy, like
shots and screenings;
- Mental health care, like counseling; and
- Treatments that help you recover from injuries.
Some plans might
cover more than that, but that’s
the minimum. You can also find dental coverage in the marketplace, either
included in a plan you buy, or separately.
also must cover what are called “preexisting health conditions.” This means
they must cover you even if you are already sick or pregnant.
See each week’s
“Hey, Doc” Q&A and a lot more at texmed.org/Heydoc
as well as in TMA’s patient blog at MeAndMyDoctor.com. And TMA’s “Hey,
help people understand how to navigate the marketplace.
Doc” content schedule through January:
Jan. 14: Who can
sell me insurance through the marketplace? How do I pick a plan? How many plans
can I pick? Can I keep the plan I have now?
Jan. 21: Who will
take care of me? What are the networks? How do I pick a doctor? Where can I
find this information?
Jan. 28: Can I keep
my doctor or hospital when I sign up? How do I find out if my doctor is on my
insurance plan’s list? What should I do if I thought my doctor was included but
TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
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