Coverage you can afford, understand & use.

Afford

  • Low Monthly Premiums
  • Low Copays
  • Low Annual Deductibles
  • Free Generic Prescriptions with Most Plans
  • Free Preventative Care

Find Out How

Understand

  • Why You Need Health Insurance
  • Protection When You Get Sick
  • Protection Because Accidents Happen
  • No Denial for Pre-Existing Conditions

Learn More

Use

  • Improve Your Health
  • Doctor Visits
  • Urgent Care
  • Flu Shots
  • Hospitalization
  • Emergency Services
  • Prescription Drugs

Explore Plans

 

You must enter a zip code to see if you're eligible
for a CareSource Just4Me Health Insurance Plan in your area.

 
 

Silver
Greatest cost savings based on income & family size.

  • Low monthly premiums.
  • Higher annual deductible, copays, coinsurance & out-of-pocket costs.
 

Ultra Gold
Coverage for those who visit the doctor frequently.

  • Higher monthly premiums.
  • Lower out-of-pocket cost.
 

Bronze
Coverage for those who rarely need a doctor.

  • Lowest monthly premiums.
  • Highest out-of-pocket costs.
 

Plan Features

  • Low premiums, low annual deductible, low copays.
  • Low copays for primary care doctor visits.
  • Low or no copays for prescriptions with Silver plans.
  • Free generic medications with Silver & Ultra Gold plans.
  • Network of doctors & providers.
  • CareSource24®, 24/7/365 nurse advice line.
  • Healthy living programs.
 

Essential Health Benefits

  • Free preventive & wellness services (mammograms, diabetes screenings, flu shots & more).
  • Prescription drugs.
  • Outpatient services (doctor visits, urgent care, diagnostic testing & more).
  • Hospitalization (such as surgery).
  • Emergency services.
  • Mental health, behavioral health & substance use disorder services (includes counseling & psychotherapy).
  • Pediatric services including dental & vision care for kids.
  • Maternity & newborn care.
  • Laboratory services.
  • Rehabilitative/habilitative services & devices.
 

Dental & Vision

  • An optional benefit covering members 18 & over.
  • Two routine dental exams with cleanings per year.
  • One routine eye exam per year.
  • Prescription lenses, contacts & frames*.
  • Allowances for Basic dental (X-rays & fillings) & major dental (impactions & dentures).
 

What do I Pay?

Health insurance costs can be confusing. That’s why it’s important that you understand what you pay and what CareSource Just4Me pays when you use your benefits.


Premium.

A premium is an amount you pay for your insurance plan each month.

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You pay this amount even if you don't use medical care that month. Your health insurance premium is similar to your auto insurance premium. You pay it monthly so that you are covered when you need it.


Coinsurance & Copayment.

Coinsurance & copayments (or copays) are set amounts you pay each time you use some services, such as going to see your primary care provider or specialist.

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When services have a coinsurance or copay, you pay the health care provider that amount, usually at the time of service. CareSource Just4Me pays the provider the balance of the bill.

  • Coinsurance is typically a percent of a bill.
  • Copayment is typically a set dollar amount.

If...

Your copayment for a primary doctor’s office visit is $20.

You visit your doctor, and the amount is $125.

You pay the doctor the $20 copayment.

CareSource Just4Me pays the doctor $105.

If...

Your coinsurance for a medical procedure is 30 percent.

The amount of the medical procedure is $600.

You pay the provider 30 percent or $180.

CareSource Just4Me pays the remaining 70 percent or $420.


Deductible.

An amount of money that insurance plans require you to pay once a year before CareSource starts to pay its share.

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The deductible does not apply to all health care services. For example, doctor’s office visits to your primary care provider do not have an annual deductible. Even if you have not yet met your annual deductible, you can still see your primary care provider. You may have to pay a copay for a primary care visit, depending on your plan.

For some services, CareSource Just4Me pays eligible expenses after you have met your annual deductible. When services have an annual deductible, you pay the health care provider for services until you have met the annual deductible amount. CareSource Just4Me pays the provider for eligible expenses after you have paid this amount. Your annual deductible starts over every January.

If...

Your copay for a primary care (doctor’s office) visit is $20.

You visit your doctor, and the amount is $125.

You pay the doctor the $20 copayment.

CareSource Just4Me is responsible for the remainder of the amount, $105.

To visit the emergency room (ER), a deductible does apply.

If...

Your plan requires you to pay $300 for an ER visit after you’ve met your deductible.

Your annual deductible is $200, and your ER amount is $2,200.

This means you need to pay $200 to meet your deductible plus the $300 copay for the ER visit.

CareSource Just4Me is responsible for the remainder of the amount, $1,700.

At this point, you have met your annual deductible of $200 for the year.

This deductible applies to other services too. After you have met your annual deductible (in this example, $200), any service that has a deductible will only require you to pay the copay or coinsurance amount for the rest of the year.

Please note that not all out-of-pocket costs go toward meeting your deductible. Coinsurance, copays and premiums do not count toward your annual deductible.

As in the example above, the $20 copay for the doctor’s office visit did not go toward the $200 deductible amount.


Out-of-Pocket.

Out-of-pocket costs are what you pay during the year through deductibles, copays and coinsurance.

Learn More

Premiums and services not covered by CareSource Just4Me do not count toward your out-of-pocket maximum. After you meet your annual out-of-pocket maximum, CareSource Just4Me begins to pay 100 percent for covered health benefits. Your out-of-pocket maximum starts over each January.

If...

Your annual out-of-pocket maximum is $650, and your annual deductible is $200.

You visit the ER, and the amount is $2,200.

Your plan requires you to pay $300 for an ER visit after you’ve met your deductible.

This means you need to pay $200 to meet your deductible plus the $300 copay for the ER visit.

CareSource Just4Me is responsible for the remainder of the amount, $1,700.

At this point, you have paid $500 toward your out-of-pocket maximum and have met your deductible.

Now, your doctor recommends that you have a magnetic resonance imaging (MRI) scan.

If...

Your plan requires you to pay $150 for an MRI after meeting your deductible.

The MRI amount is $2,500.

Because you’ve already met your deductible, you pay the $150 copay and CareSource Just4Me is responsible for the remaining $2,350.

At this point, you have met your $650 annual out-of-pocket maximum. For the rest of the benefit year, CareSource Just4Me will pay 100 percent of covered services as defined in the plan’s Summary of Benefits and Coverage or Schedule of Benefits. To find these documents for your CareSource Just4Me plan, access our Plan Details.

Want to learn more about paying for insurance, enrolling in a plan and coverage and benefits? Access our Frequently Asked Questions for more information.

How Can I Save?

When you enroll, the Health Insurance Marketplace determines your eligibility for cost savings based on your income and family size.

View Table

Simulation of eligibility ranges:

Number of people in your household123456
Yearly Income$11,670- $46,680$15,730- $62,920$19,790- $79,160$23,850- $95,400$27,910- $111,640$31,970- $127,880

Two types of cost savings through the Health Insurance Marketplace:

  • Cost sharing reduction
  • Advance premium tax credit (or subsidy)

Cost Sharing Reduction.

A cost sharing reduction is a discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance and copayments.

Learn More

When you enroll through the Marketplace and review the plans you qualify for, this discount will be built into your Silver level plans. This discount is what makes the Silver plans so cost effective.


Advance Premium Tax Credit.

An advance premium tax credit is a tax credit or subsidy that can be used in two ways.

Learn More

If you use the tax credit to lower your monthly premiums, you get the savings throughout the year. If you apply your tax credit to next year’s tax return, you increase your chance of getting money back at tax time. You decide how to use your tax credit when you enroll through the Health Insurance Marketplace.

  • Right away to lower your monthly premium payments
  • When you file your federal tax return
 
1Enter Details
 
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3Cost Estimate
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YOUR COST
 
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Estimate only.
Please read disclaimer below.

4Your Estimated Plan Summary

CareSource Just4Me  

$0/month*

CareSource Just4Me   monthly premium is $0.
You could receive a government tax credit subsidy for $0 per month.

Estimate Disclaimer

This tool provides an estimate of the amount of federal premium assistance that may be available to lower the cost of health insurance purchased directly by an individual through the Health Insurance Marketplace. The results are only estimates, and actual federal premium assistance may vary. This tool does not factor in family members with other health coverage from an employer, Medicaid/CHIP or Medicare. Exact calculations of federal premium assistance will occur when an individual’s eligibility is determined and the individual enrolls through the Health Insurance Marketplace at healthcare.gov. This tool is not an application for insurance or an offer to provide or guarantee insurance coverage. Using this tool does not require you to enroll in any product or service. This tool does not provide legal or financial advice of any kind and is intended for informational purposes only.

 
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CareSource Just4Me Special Enrollment Period

Did you get married, have a baby, recently move or switch jobs?

Did you know you can enroll in CareSource Just4Me™ after open enrollment has ended?

If you have a life change event, you are eligible for the special enrollment period (SEP) through the state or federal Marketplace.

The special enrollment period is going on now.

Get started today!

Start an application by creating a CareSource Just4Me account. After you create an account for CareSource Just4Me, you will be routed to the state or federal Marketplace to complete your application.

Life Change Events Include

  • Getting married
  • Having a baby
  • Gaining citizenship
  • Leaving incarceration
  • Moving outside your insurer’s coverage area.
  • Adopting a child or placing a child for adoption or foster care
  • Losing other health coverage due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar circumstances.
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
  • Having a change in income or household status that affects eligibility for advance premium tax credits or cost-sharing reductions IF you are already enrolled in coverage through the Marketplace.

Important:

Voluntarily ending coverage doesn’t qualify you for a Special Enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.

Already enrolled in a CareSource Just4Me Plan?

Remember, if you have a life change event you will need to check your personal information on the Marketplace to ensure you still qualify for the same health insurance coverage. To get started login to your CareSource Just4Me account and you will be routed to the state or federal Marketplace.

Do you qualify for the Special Enrollment Period?

Start an application by creating a CareSource Just4Me account. After you create an account for CareSource Just4Me, you will be routed to the state or federal Marketplace to complete your application.

Find out why a CareSource Just4Me insurance plan is just right for you.  Review our Frequently Asked Questions (FAQs) for answers to your questions.

Just4Me

Health Insurance Marketplace

  • Health Insurance Marketplace

    • What is the Health Insurance Marketplace?
      • The Health Insurance Marketplace (sometimes referred to as the Health Insurance Exchange) is an online marketplace that allows you to purchase health insurance at a competitive rate and maybe even qualify for lower costs. Some states use the federal Marketplace. Other states, such as Kentucky, have created their own Marketplace. The Kentucky Marketplace is called kynect.

        Regardless of the state, the Marketplace offers a solution for people who are currently uninsured. It may even offer a better option for some who are paying for high cost health insurance now. It is designed to be a "one stop shop" option where you can compare policies sold by different companies. Purchasing insurance can be confusing, so information on the plan benefits is standardized so that it is easier for you to compare costs and quality.

        Enrolling through the Marketplace is the only way you can qualify for help paying your insurance costs, based on your income and family size.


    • Why is this important?
      • In 2015, most people are required to have health insurance or pay a tax penalty. For those who are uninsured now or who are paying a high cost for current insurance, the Health Insurance Marketplace offers a great option for affordable health insurance coverage.

    • What is the benefit of using the Marketplace?
        • The Marketplace was created to make the process of selecting health insurance easier to understand and to provide affordable options.
        • All health insurance plans in the Marketplace must cover essential health benefits, making it easier to compare policies.
        • Insurance companies on the Marketplace can’t charge more or deny coverage because of pre-existing conditions or gender.
        • Plans sold through the Marketplace cannot have annual or lifetime limits on health insurance coverage.
        • The Marketplace also helps people who can’t afford the full cost of insurance by providing cost savings that will lower the amount they have to pay.
        • The amount of your cost savings depends on your income and family size. If your income falls within the following ranges, you'll generally qualify for a tax credit. The lower your income within these ranges, the bigger your credit.

        In Kentucky and Ohio:

          • $16,105 to $46,680 for an individual

          • $21,707 to $62,920 for a family of 2

          • $27,310 to $79,160 for a family of 3

          • $32,913 to $95,400 for a family of 4

          • $38,516 to $111,640 for a family of 5

          • $44,119 to $127,880 for a family of 6

          • $49,721 to $144,120 for a family of 7

          • $55,324 to $160,360 for a family of 8

        In Indiana:

          • $11,670 to $46,680 for an individual

          • $15,730 to $62,920 for a family of 2

          • $19,790 to $79,160 for a family of 3

          • $23,850 to $95,400 for a family of 4

          • $27,910 to $111,640 for a family of 5

          • $31,970 to $127,880 for a family of 6

          • $36,030 to $144,120 for a family of 7

          • $40,090 to $160,360 for a family of 8


    • Will CareSource be part of the Marketplace?
      • CareSource is a "Qualified Health Plan" or "QHP" on the Health Insurance Marketplace in Ohio, Kentucky and Indiana for 2015 enrollment, which begins November 15, 2014.
        To be designated as a QHP, health insurance companies must meet rules established by the government as part of the Patient Protection and Affordable Care Act, also known as health care reform.
        CareSource is a nonprofit organization. We pride ourselves on understanding our members and helping them understand and access their health insurance services. CareSource has over 25 years of experience with managed health care coverage. We serve more than a million members with high member satisfaction rates. We are focused more on people than profits.
    • How do I access the Marketplace?
      • If you are an Ohio or Indiana resident, visit HealthCare.gov

        If you are a Kentucky resident, visit kynect.ky.gov.

        Visit these websites to learn about the health care laws and their impact on you.

        If you have a qualifying life event, such as the birth of a child or loss of other health coverage, you can enroll during a special enrollment period.

        Open enrollment for 2015 starts November 15, 2014, when you can access these sites to apply for coverage, compare available health insurance plans and enroll in a plan.


    • Do I have to buy insurance through the Marketplace?
      • Federal law requires most people to have health insurance or pay penalties. This is part of the Patient Protection and Affordable Care Act, otherwise known as health care reform. 

        So, while you do not have to buy insurance from the Health Insurance Marketplace, most people have to be covered or pay a penalty. Using the Marketplace allows you to compare available plans, ensure you receive essential health benefits and determine your eligibility for cost savings.

    • Where can I get more information?
      • We will continue to update information about the Health Insurance Marketplace on this website, so come back often.  

        You can find more information at HealthCare.gov in Ohio and Indiana or at kynect.ky.gov in Kentucky. 

  • Eligibility

    • Who is eligible for the Marketplace?
      • Three requirements must be met to be eligible for health insurance through the Marketplace:

        • You must live in the U.S.
        • You must be a U.S. citizen or national (or lawfully present).
        • You can’t be currently incarcerated.
    • Can I provide coverage for my family through the Marketplace?
      • Yes, some health insurance plans will offer family coverage and others will offer individual coverage for each member of your family. This allows you to customize your health insurance coverage so that it fits the needs of you and your family.

    • Can I provide coverage for my adult children?
      • If your children are under age 26 and meet certain requirements, you can insure them under your family policy if the health insurance plan covers dependents. This is true even if your children live on their own. Coverage up to age 26 is only a minimum. State rules and individual insurance plans can extend dependent coverage past age 26.

        Before the health care reform law, insurance companies could stop covering dependent children at age 19 or when they were no longer full-time students.

    • I can get insurance through my employer. Can I buy insurance through the Marketplace?
      • Individuals who can get insurance through their employers can buy insurance through the Marketplace if their premiums are unaffordable (more than 9.5 percent of their household income) or if the plan is inadequate (pays less than 60 percent of the cost of covered benefits).

  • Coverage

    • What health care benefits are covered through the Marketplace?
      • In general, essential health benefits are covered under the plans offered through the Marketplace. All plans cover the following services:

        • Free preventive and wellness services (such as mammograms, diabetes screenings, flu shots and more)
        • Prescription drugs
        • Outpatient services (such as primary care and specialty doctor visits, urgent care services, diagnostic testing and more)
        • Hospitalization (such as surgery)
        • Emergency services
        • Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
        • Pediatric services including dental and vision care for kids
        • Maternity and newborn care
        • Laboratory services (such as blood drawn)
        • Rehabilitative and habilitative services and devices (to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

        Some plans provide additional benefits, for example, adult dental and vision care. Plans range from basic with minimal coverage to all encompassing high-end plans.

    • Will pre-existing conditions be covered?
      • The health care laws are designed to protect you and your family. Health insurance companies can't refuse to cover you just because you have a chronic or pre-existing condition. In addition, they can’t charge more for women than for men. All of the plans offered through the Marketplace comply with these health care laws.

    • Are preventive services such as vaccines for children or mammograms for women covered?
      • Yes. All health insurance plans offered through the Marketplace cover preventive services at no cost to you.  This means you do not have to pay a copayment or coinsurance even if you haven't met your yearly deductible.

        Preventive services are designed to prevent, identify and treat diseases early. These include flu shots and immunization vaccines, screenings to identify diseases, contraception and mammograms for women, behavioral assessments for children and much more.

    • Are there lifetime limits on the amount that insurance companies will cover?
      • No. Insurance companies cannot impose annual or lifetime dollar limits on essential health benefits. In the past, people with cancer or other chronic illnesses could run out of insurance coverage because insurance companies could limit the amount they would pay during a year or over a lifetime.

  • Enrollment/Reenrollment

    • What is the time frame for buying insurance through the Marketplace?
      • If you have a qualifying life event, such as the birth of a child or loss of other health coverage, you can enroll during a special enrollment period, which ends 60 days after the life event.

        Starting on November 15, 2014, you can enroll in a health care plan for 2015 through the Marketplace during open enrollment. You must enroll by December 15, 2014, if you want new coverage to begin January 1, 2015.

        Open enrollment will close on February 15, 2015.  This means that you will have three months, from November 15, 2014 through February 15, 2015, to buy health insurance from the Marketplace.  Remember, you must have health insurance or pay a penalty. 

    • What information do I need to enroll in the Marketplace?
      • In order to enroll through the Marketplace, you will need the following information for each family member to be covered:

        • Social Security number or document number for legal immigrants
        • Employer and income information, for example, wage and tax statements from pay stubs or W-2 forms
        • If currently covered by health insurance, the policy number
        • If eligible for employer health insurance coverage (even if the coverage is through another person’s job, for example, a spouse’s or a parent’s) information about the employer’s health insurance plan
    • I don’t use a computer. Are there other ways to buy insurance through the Marketplace?
      • You will be able to apply online, by phone, by mail and in person. 

    • I am currently enrolled in a Marketplace plan. Do I need to reenroll?
      • If you bought coverage through the Marketplace in 2014, you will be notified if you are eligible to continue with the same coverage in 2015 and if your options for financial assistance have changed.

        This process begins when the Marketplace sends you an annual redetermination notice. You need to review, sign and return this notice promptly. If any of the information is inaccurate, contact the Marketplace. If you do not sign and return the notice within 30 days, the Marketplace will assume the information is correct.

        The Marketplace will then notify you with a final decision regarding eligibility for coverage and financial assistance, including whether you are eligible for programs such as Medicaid or the Children’s Health Insurance Program (CHIP). 

        If you are eligible to continue to receive Marketplace coverage, you can either keep your current plan or change plans during open enrollment, which is November 15, 2014 to February 15, 2015. You will be automatically reenrolled in your current plan if you do nothing. If your current plan’s benefits have changed, you will be notified of these changes.

    • Can I keep the Marketplace plan I selected in 2014?
      • If you enrolled in a Marketplace health insurance plan last year and the Marketplace has determined that you remain eligible for Marketplace coverage, you will be automatically reenrolled in the same plan for 2015 that you selected for 2014. If the cost or coverage details of your plan have changed from 2014 to 2015, your insurance plan will notify you of these changes.

    • Can I switch to another Marketplace plan for 2015?
      • If you enrolled in a Marketplace health insurance plan last year and the Marketplace has determined that you remain eligible for Marketplace coverage, you can change to another Marketplace plan during open enrollment, which is November 15, 2014 to February 15, 2015. To change plans, go to the Marketplace, access your account, shop for plans and select the plan that best suits your needs.

  • Costs

    • How much does Marketplace insurance cost?
      • The cost of health insurance through the Marketplace depends on the plan you choose, your age and your tobacco use. Regardless of the plan you choose, all costs are stated up front so you’ll know how much you’ll be paying and what you’ll be getting before you make a choice.

        You may qualify for tax credits that will lower your monthly payments based on family income and size. The Marketplace will show you the amount of these lower payments when you enroll starting November 15, 2014. 

    • How can I determine if I qualify for lower costs?
      • You will be able to determine if you qualify for lower costs when you enroll through the Marketplace starting November 15, 2014. The Marketplace will tell you if you qualify for Medicaid, the Children’s Health Insurance Program (CHIP) or a tax credit.
        If your income falls within the following ranges, you'll generally qualify for a tax credit through the Marketplace. The lower your income within these ranges, the bigger your credit.
        In Kentucky and Ohio:
        • $16,105 to $46,680 for an individual
        • $21,707 to $62,920 for a family of 2
        • $27,310 to $79,160 for a family of 3
        • $32,913 to $95,400 for a family of 4
        • $38,516 to $111,640 for a family of 5
        • $44,119 to $127,880 for a family of 6
        • $49,721 to $144,120 for a family of 7
        • $55,324 to $160,360 for a family of 8
        In Indiana:
        • $11,670 to $46,680 for an individual
        • $15,730 to $62,920 for a family of 2
        • $19,790 to $79,160 for a family of 3
        • $23,850 to $95,400 for a family of 4
        • $27,910 to $111,640 for a family of 5
        • $31,970 to $127,880 for a family of 6>
        • $36,030 to $144,120 for a family of 7
        • $40,090 to $160,360 for a family of 8
    • How can the Marketplace lower my monthly premium payments?
      • When you buy health insurance coverage through the Marketplace, you may be able to get a premium tax credit or subsidy that can lower the amount you pay each month for your premium. The amount of your tax credit depends on your household size and income.

        When you enroll through the Marketplace, you will find out the amount of your tax credit. At that time, you can choose to apply the amount equally to your monthly premium payments or you can wait until you file your federal tax return.

        If you apply the amount to your monthly premium, you get the benefit of lower monthly payments throughout the year. If you apply some or all of your tax credit to next year’s tax return, you increase your chance of getting money back at tax time.

    • Are there other cost savings I could qualify for?
      • Yes. In addition to the tax credit that reduces your monthly premium payment, you may qualify for cost sharing reductions. If you qualify for these, you will pay lower out-of-pocket deductibles, copayments and coinsurance if you choose a health plan from the Silver category.

    • What if I qualify for cost savings through the Marketplace and my income changes after I enroll?
      • When you enroll, you estimate your earnings for next year, and this estimate determines your cost savings. You must report any income change, up or down, that impacts your eligibility for cost savings to the Marketplace at HealthCare.gov in Ohio and Indiana and at kynect.ky.gov in Kentucky. Otherwise, you may miss out on the cost savings or end up owing money if you no longer qualify for the cost savings.

        So, if your income changes your estimated earnings for the year, for example, through a job change or job loss, you should report it to the Marketplace.

        You must also notify the Marketplace in the following situations:

        • If you become pregnant
        • If you have a baby
        • If your address or phone number changes
        • If your immigration status changes
        • If your marital status changes
        • If you become eligible for other health care coverage
    • How much is the penalty if I don’t have health insurance?
      • If you don't have health insurance coverage, you may have to pay a penalty at tax time. This penalty is also referred to as the "individual responsibility payment" or "individual mandate." You also have to pay for all of your health care.

        The penalty takes effect starting with your 2014 federal income tax return. Most people will file this return in 2015.

        The penalty in 2014 is calculated in one of the following ways. If you or your dependents don’t have qualifying insurance, you'll pay whichever of these amounts is higher:

        • 1 percent of your yearly household income
        • $95 per person for the year ($47.50 per child under 18)

        The way the penalty is calculated, a single adult with household income below $19,650 would pay the $95 flat rate. A single adult with household income above $19,650 would pay an amount based on the 1 percent rate. (If income is below $10,150, no penalty is owed.)

        The penalty increases every year. In 2015 it’s 2 percent of income or $325 per person. In 2016 and in later years it’s 2.5 percent of income or $695 per person. After that it's adjusted for inflation.

  • Health Insurance Basics

    • What is insurance?
      • Insurance protects you from high costs when something bad happens. No one plans to get sick or hurt, but most people need to get treated for an illness or injury at some point, and health insurance helps pay these costs. You get health insurance to protect you when you need medical care.

        When you understand how health insurance works, it helps you be an informed consumer so you can find coverage that fits your needs.

    • What is health insurance?
      • Health insurance is a contract between you and your insurance company. You buy a plan or policy, and the company agrees to pay part of your medical costs when you get sick or hurt. Even when you need care that costs more than you pay in premiums and deductibles, insurance will cover the care you need. A standard health insurance plan also gives you access to preventive care to keep you healthy, like vaccines and check-ups. Many plans also cover prescription drugs.

        Your health insurance plan will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations.

    • How do you pay for health insurance?
      • You’ll usually pay a premium every month for health insurance, and you may also have to pay a deductible once each year before the insurance company starts to pay its share. How much you pay for your premium and deductible is based on the type of insurance you have.

        Just as important as the premium cost is how much you have to pay when you get services. Examples include:

        • How much you pay before your insurance coverage starts (a deductible) 
        • What you pay out-of-pocket for services after you pay the deductible (coinsurance or copayment)
        • How much in total you’ll have to pay if you get sick (the out-of-pocket maximum) 

        What your policy covers is often directly related to how expensive the health insurance policy is. The policy with the cheapest premium may not cover as many services and treatments.

    • What is a premium?
      • A premium is an amount you pay for your insurance plan each month. You pay this amount even if you don't use medical care that month. Your health insurance premium is similar to your auto insurance premium. You pay it monthly so that you are covered when you need it.

    • What is a deductible?
      • A deductible is an amount some insurance plans require you to pay once each year before the insurance company starts to pay its share. For example, let's say you have a $200 deductible. You go to the doctor and the total cost is $1,000. You pay the first $200 to cover the deductible, and then your insurance pays the remaining $800.

    • What is coinsurance or a copayment?
      • Coinsurance or a copayment is an amount that you pay as your share of the cost when you get a medical service, like a doctor's visit or a prescription. Coinsurance is usually a percentage amount (for example, 20% of the total cost). A copayment is usually a set dollar amount (for example, you might pay $10 or $20 for a prescription or doctor's visit).

    • What is an out-of-pocket maximum?
      • This is the maximum amount that you could pay for medical care that is not reimbursed by insurance. Out-of-pocket costs can include deductibles, coinsurance and copayments for covered services. After you've reached your out-of-pocket maximum, your insurance plan must pay for all of your covered medical care with no limit.

    • Are all health insurance plans the same?
      • No. There are many kinds of health insurance plans. Some plans allow you to visit almost any doctor or health care facility. Others limit your choices to a network of doctors and facilities or require you to pay more if you see doctors outside the network.

        It is important to understand what each plan covers, the terms of the plan and any limitations before you purchase a plan. The Summary of Benefits and Coverage (SBC) provides information about health plan coverage in a common format so you can easily compare plans.

    • Why is it important to have health insurance?
      • A single visit to a primary care doctor can cost between $150 and $200. The average cost of a 3-day hospital stay is $30,000. Fixing a broken leg can cost up to $7500. Having health insurance coverage can help protect you from high, unexpected costs like these. People without health coverage are exposed to these costs, which can sometimes lead people without coverage into deep debt or even into bankruptcy.

Need additional information? Call us at 1-800-479-9502 or provide your contact information and we will contact you.  We can help you navigate the Health Insurance Marketplace and enroll in a CareSource Just4Me insurance plan.