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Patient Information about The Health Insurance Marketplace

Patient Info about the Health Insurance Marketplace Video

Nine Things You Need to Know about the Health Insurance Marketplace

Health Insurance Marketplace Lunch and Learn

Many changes are ahead for health insurance options including expanded Medicaid, different plans, and higher penalties if you don’t choose coverage for 2016. Enroll by December 15, 2015, for coverage to begin January 1, 2016. This Lunch & Learn (total running time - 44:11) was presented by Family Medicine Physician Michael Temporal, MD, Health Policy Director JJ Carmody, Payer Relations Director Becky Kelly and Payer Relations Associate Jan Hoy.

1. Should I care about health insurance?

Yes! Health insurance is important for better health. Those with health insurance are more likely to receive preventive health care, such as screenings and annual exams, and are less likely to go to the Emergency Department for non-emergency needs.

In addition, most individuals are required by law to have health insurance every year. Open Enrollment is only available until January 2016. We recommend that you enroll before December 15, 2015, so that coverage will begin on January 1, 2016. (Note that some individuals can enroll later due to “life changes,” which may include death, divorce, birth or a change in employer coverage.)

2. Can I just wait to sign up if I get sick or injured?

No, health insurance is not retroactive and will not cover care that has already been provided. In addition, it could take from two-to-six weeks for a new health insurance plan to become active during the Open Enrollment period. After January 31, 2016 you will not have another opportunity to obtain coverage until November 2016, effective January 2017, unless you qualify for a Special Enrollment Period.

3. Will I save money? Can I get a discount?

Most Montanans will qualify for lower premiums or some financial assistance on health insurance through the Health Insurance Marketplace, in the form of tax credits to offset the monthly premium cost for coverage or discounts on the costs when medical services are received for persons with incomes between 138and 400% of Federal Poverty Level. For example, one person may qualify for lower monthly premium costs with an estimated household income from $11,770 to $47,080. Learn about more affordable health insurance options at

4. Can I see my favorite doctor?

Probably, but it’s important to make sure your favorite doctor(s), providers, hospital and pharmacy are in-network in your chosen insurance plan before you enroll. Billings Clinic is in-network with Blue Cross Blue Shield, PacificSource and Montana Health CO-OP Access Care plans. Billings Clinic is out-of-network in Montana Health CO-OP Connected Care plans and you will pay more out-of-pocket costs to see Billings Clinic under these plans.

5. Are my medications covered?

To be sure, we recommend that you check with the insurance company(ies) you are considering to see if your medications are covered by the plan’s “formulary.” The formulary is the list of prescribed medications covered by an insurance plan.

6. Can I pay less for my kid’s health insurance?

It’s very possible. Many children qualify for free or low-cost health insurance through Healthy Montana Kids, the state’s Children’s Health Insurance Program. You can find out if you qualify for Healthy Montana Kids or for financial assistance on a family health insurance plan by going to

7. If I have Medicare, do I need to do something for the Health Insurance Marketplace?

No, you don’t need to do anything. If you have questions about Medicare, please call Billings Clinic Senior Life at 406-657-4400 or toll-free at 1-800-332-7156, ext. 4400.

8. Can I change the insurance plan I already picked?

If you enrolled for 2015, you can change to another plan for 2016, or re-enroll in the plan you are in now. Once you enroll for 2016, it may be difficult to change your plan.

9. This is confusing. How can I get help?

Billings Clinic has Certified Application Counselors (CACs) who can assist you with questions or help you enroll in the Health Insurance Marketplace. Call our Certified Application Counselors at 406-238-2601 or toll-free at 1-800-332-7156, ext. 2601. Scheduled appointments are available.

In addition, there are CACs and Navigators available at many other health care organizations, hospitals and communities in our region. To find local help near you, go to and click on “Find Local Help.”

You can also get more information or enroll online at

The Health Insurance Marketplace is located at a website - - that offers individuals or small employers a place to directly compare and choose private health insurance options.

Patient Information about the Health Insurance Marketplace

Billings Clinic has been designated as a Certified Application Counselor Designated Organization. To learn more about the Health Insurance Marketplace and options for affordable coverage, call Patient Financial Services at 406-238-2601.

Important Dates
Open Enrollment - November 1, 2015 to January 31, 2016
Open enrollment for Health Insurance Marketplace (for those who don't have "affordable and adequate" coverage offered by their employer)
December 15, 2015
Enroll by the 15th for new coverage that begins on January 1, 2016. If your plan is changing or you want to change plans, enroll by December 15 to avoid a lapse in coverage.

Questions? Need To Make An Appointment?

If you have questions or would like to schedule an appointment with a Billings Clinic Certified Application Counselor (M-F, 8 am – 5 pm) please call (406) 238-2601.

Check out to find help with the Health Insurance Marketplace in your area.

Billings Clinic is a Certified Application Counselor Organization with assisters available to help patients with health insurance questions or enrollment.