Skip Navigation

Winter 2014, Volume 22, Number 1

4 ways to get marketplace coverage

Affordable Care Act Update

Health Insurance Marketplace Q&As

January 1, 2014 marked a very important milestone in health reform. On that date, key provisions of the Affordable Care Act went into effect. For many people who were uninsured, that's when coverage under new health insurance options began. Many states have expanded their Medicaid programs, which provide coverage to families with low incomes. Important consumer protections also went into effect on January 1, 2014.

To assist readers, this issue of SAMHSA News offers some commonly asked questions and their answers:

Q: What is the Health Insurance Marketplace?

A: The new Health Insurance Marketplace, sometimes known as the health insurance "Exchange," helps uninsured people find health coverage, whether it's private insurance plans or public options such as Medicaid and the Children's Health Insurance Program. While some states operate their own Marketplaces, the federal government runs the Marketplace in other states.

Q: How will the changes benefit individuals with behavioral health issues?

A: Starting in January, insurers can no longer turn people down or charge people more because they have pre-existing conditions, such as mental and/or substance use disorders. The law also stops insurers from imposing caps on lifetime coverage for essential health benefits like mental and/or substance use disorders. In addition, the list of essential health benefits that all private plans in the Marketplace must offer includes mental and/or substance use disorder services, prescription drugs, and hospitalization. Plus, all Marketplace plans and many other plans must provide free preventive services, including depression screening for adults, alcohol misuse screening and counseling, and tobacco use screening and interventions.

Q: How do individuals enroll?

A: There are four ways to apply for health coverage in the Marketplace: online, by phone, with a paper application, or in person with assistance. No matter how someone applies, they'll start by providing basic information about their income, current coverage, and so on. They'll then be able to compare all their coverage options and see if they qualify for lower costs on monthly premiums and out-of-pocket costs for private insurance.

Q: Who can help someone enroll?

A: Answers to questions or even help completing the entire application process are available over the phone, 24 hours a day, every day, in English and Spanish, at 800-318-2596 (TTY: 855-889-4325). Plus, every state offers in-person assistance to provide information about the options available and enroll individuals and families in Marketplace plans. These helpers include navigators, application assisters, certified application counselors, and the government agencies that handle a state's Medicaid and Children's Health Insurance Program. People can locate help via or call 855-889-4325 (TTY: 855-889-4325.)

Q: When does the enrollment period end?

A: The first open enrollment period for the Marketplace ends March 31, 2014.

Q: What if someone can't afford coverage?

A: The Marketplace makes it easy to compare costs of various coverage options. There are three ways to save money in the Marketplace. Depending on their income and family size, people may be able to lower their monthly premiums. They may qualify for lower out-of-pocket costs for copayments, co-insurance, and deductibles. They may also be able to get low-cost or even free coverage through Medicaid or the Children's Health Insurance Program. Because some states will be expanding eligibility for Medicaid in 2014, people may qualify even if they've been turned down in the past.

Q: What happens if someone doesn't have coverage in 2014?

A: Most people must have health coverage in 2014 or face a penalty. The fine will be $95 for adults and $47.50 for children in 2014 or one percent of household income, whichever is higher. The fee, which will increase every year, is designed to encourage all Americans to take responsibility for their health coverage.

Helping Consumers Enroll in the Health Insurance Marketplace

The new Health Insurance Marketplace and expanded eligibility for Medicaid mean that millions of Americans have access to health insurance. However, the program's promise can only be fulfilled if people actually sign up for coverage.

SAMHSA is helping to ensure that happens by working with its constituents to help those they serve to sign up for health insurance before the program's first enrollment period ends on March 31, 2014.

Toolkits Now Available

With its Enrollment Coalitions Initiative, for example, SAMHSA is partnering with almost 40 national behavioral health organizations. Organized into five coalitions representing different constituencies, the organizations are developing training and resources to help community-based organizations and professionals explain the new options and get uninsured individuals to apply.

To help coalition members and others achieve that goal, SAMHSA has developed the Getting Ready for the Health Insurance Marketplace toolkit.

The 30-minute interactive online toolkit has three sections. The first summarizes the Affordable Care Act, how the law works, and why it's so important for uninsured people with behavioral health conditions. The second section explains how the Health Insurance Marketplace works, how to apply for coverage, and where to get help. The final section offers ideas and resources for raising awareness among uninsured individuals and motivating them to enroll.

Many of the materials, which include articles, brochures, fact sheets, presentations, videos, posters, and more, are available in multiple languages. Some materials are customized for specific racial or ethnic populations.

In addition to the general toolkit, there are five toolkits customized for use by specific kinds of groups. Based on input from the coalitions, they include the Community-Based Prevention Organizations Toolkit; Consumer, Family, Peer, and Recovery Community Organizations Toolkit; Housing and Homeless Services Organization Toolkit; Mental Health and Substance Use Providers Toolkit; and Criminal Justice Organizations Toolkit. All are available at SAMHSA's Enrollment Coalitions Initiative website.

Training for Call Center Staff

Another source of help for consumers seeking information about the Health Insurance Marketplace are federal call centers, including three operated by SAMHSA.

SAMHSA has trained staff at its three call centers – the Suicide Prevention Lifeline at 800-273-8255, Treatment Referral Line at 800-662-4357, and Disaster Distress Helpline at 800-985-5990 to provide information, answer questions, and refer callers to more help if needed.

Call center staff can provide information on such topics as the new health coverage under the Affordable Care Act, how to prepare for enrollment, how to enroll, and the enrollment and coverage timeline. The staff can also provide help to people covered under Medicare, Medicaid, and the Consolidated Omnibus Reconciliation Act (COBRA), which allows people to keep employer-based health insurance for up to 18 months after losing their jobs or full-time employment status.

If call center staff can't address callers' needs, they then refer them to the Health Insurance Marketplace call center at 800-318-2596 (TTY: 855-889-4325).

Revamped Health Reform Site

SAMHSA has also completely updated its own health reform website.

"We've overhauled all the content and added a whole bunch of new resources," said Kevin J. Malone, a public health analyst in SAMHSA's Office of Policy, Planning, and Innovation. "We've really significantly improved it as a resource."

The site includes sections on health reform basics, prevention efforts under health reform, primary and behavioral health integration, and SAMHSA's own health reform-related activities, among other sections. There's also information about BHbusiness for Providers, a SAMHSA initiative to ensure that behavioral health providers are ready to meet an increased demand for services.


Share This Article: