FAQ


Are you looking for Health Insurance? 

There are health insurance options available to you and your family: employer coverage, the health insurance marketplace, Medicaid, Medicare, and more. Individuals can receive assistance in several different ways: in-person assistance such as Navigators, Certified Application Counselors, agents, and brokers. If you’re looking for help find assistance near you: https://localhelp.healthcare.gov/

You can receive free assistance from Certified Application Counselors (CACs) by contacting Ohio Hills Health Services (OHHS). OHHS is a Marketplace-designated organization in Ohio, who was granted the opportunity to provide CACs to our community. CACs are available year-round to provide health insurance assistance to anyone, not just OHHS patients. CACs perform many functions such as educating consumers and helping them complete a confidential, unbiased application for health coverage. OHHS Certified Application Counselors can assist consumers in both expanded Medicaid applications and health insurance applications through the Health Insurance Marketplace. CACs can help consumers explore their enrollment options, account renewals, assist in updating a consumer's information and applying forexemptions.

Ohio Hills Health Services CACs are also Ohio Senior Health Insurance Information Program (OSHIIP) Volunteers, this means they can provide free unbiased Medicare education and enrollment assistance in addition to the regular CAC duties.

Contact a CAC now:

Brandy Stephens

[email protected]

Call: 1-740-239-OHHS (6447) Ex.1023

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Do I need Health Insurance?

Health insurance is a way to pay for health care. Health insurance can protect you from paying the full costs of medical services when you’re injured or sick such as provider services, medications, hospital care, and special medical equipment. However, health insurance is also important to keep you healthy because health insurance can also pay for immunizations, annual check-up, health screenings, counseling and more.

Just like car insurance to repair your car and home insurance to repair your home, health insurance can help maintain or repair you. Insurance can help protect you and your family from unaffordable expenses. With health insurance, you can choose a plan and agree to pay a certain rate, or premium, each month. In return, your health insurer agrees to pay a portion of your covered medical costs. 

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How Do I know What Insurance I qualify for?

If you are working your employer may offer health insurance and you should talk to your employer about any possible insurance you may be eligible for as well as when their open enrollment period may occur.

If you do not qualify for employer coverage, you may qualify for other coverage like Medicare at age 65 or older, Medicaid or CHIP depending on income, household size and age, there is health insurance through the Health Insurance Marketplace or you can purchase insurance off the marketplace through an agent or broker.  

The easiest way to determine application eligibility is to review income and household size. You can use this tool as a guide:

https://www.healthcare.gov/lower-costs/

Who do I include in my household?

https://www.healthcare.gov/income-and-household-information/household-size/

How do I figure my household income?

https://www.healthcare.gov/income-and-household-information/how-to-report/

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Can you tell me more about the Health Insurance Marketplace?

As of October 2013, consumers could access health insurance through the Health Insurance Marketplace. Every year the Health Insurance Marketplace sets an open enrollment period for consumers to enroll or re-enroll in their marketplace health insurance plans. If consumers miss the open enrollment period and they do not qualify for a special enrollment period then they may have a penalty when they file their taxes.

The 2019 open enrollment period will operate from November 1, 2018 – December 15, 2018

The Health Insurance Marketplace was designed for individuals who do not have access to affordable employer-based health coverage and for individuals who do not qualify for other Insurance Affordability Programs such as Medicaid or CHIP.

Some individuals may be eligible for income-based subsidies such as,  Advanced Premium Tax Credits (APTCs)  and Cost Sharing Reductions (CSRs). After completing an application you will receive eligibility results that will tell you whether you're eligible to purchase health insurance through the Health Insurance Marketplace as well as your eligibility for lower costs.

REMINDER:

  • If you incorrectly report your income or if you do not keep your Marketplace account current the IRS will request a full or partial reimbursement to cover the amount the IRS overpaid to you throughout theyear.
  • If you are married, you must file your taxes married filing jointly in order to receive APTC or CSR.
  • If your employer offers health insurance, you may not be eligible to receive APTC or CSR through The Health Insurance Marketplace, you can use the Employer Coverage Tool to help collect the information needed for your marketplace application.

Can I see health insurance marketplace plans before I apply?

https://www.healthcare.gov/see-plans/

How do I apply to the Health Insurance Marketplace?

  • In-Person Assistance from a Certified Application Counselor at Ohio Hills Health Services:

Brandy Stephens

[email protected]

Call: 1-740-239-OHHS (6447) Ex.1023

  • https://www.healthcare.gov/
  • Call the Health Insurance Marketplace at 1-800-318-2596
  • Print off a paper application, complete, and mail it into the Health Insurance Marketplace

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Can you tell me more about Ohio Medicaid and CHIP Program?

https://www.medicaid.gov/medicaid/by-state/stateprofile.html?state=Ohio

What Benefits are covered by Ohio Medicaid?

https://www.medicaid.gov/medicaid/benefits/list-of-benefits/index.html

Can you tell me about Medicaid and Estate Recovery?

https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html

 

How do I apply for the Ohio Medicaid program?

  • In-Person Assistance from a Certified Application Counselor at Ohio Hills Health Services:

Brandy Stephens

[email protected]

Call: 1-740-239-OHHS (6447) Ex.1023

What can I expect after applying for Medicaid?

http://www.medicaid.ohio.gov/FOROHIOANS/GetCoverage/WhattoExpect.aspx

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Can you tell me more about Medicare?

Generally, there are two different scenarios you could choose to get your Medicare coverage, but the decisions are based on what is right for you in your situation. Most Medicare recipients will need to enroll in Part A (Hospitalization coverage)  and Part B (Medical coverage).

However, several Medicare recipients will also need to enroll in an additional plan/plans to help them cover the extra medical services that are not covered by Part A and Part B. One such scenario Medicare recipients could choose from would be: a Supplement Plan to help cover the gaps in Medicare as well as a Part D (prescription drug coverage) plan; or Medicare recipients could choose option two: a Medicare Advantage Plan. If you are eligible for retirement coverage through your employer you should work with you benefits administrator to make a smooth transition onto Medicare.

Are you getting ready to turn 65?

Medicare enrollment may be a daunting task, but it's best to start the enrollment process in a timely fashion. Individuals can start the Medicare enrollment process as early as 3 months before their 65th birthday, but remember your initial enrollment period will end 3 months after your 65th birthday (7 months total for your Initial Enrollment Period).

To start your Medicare benefits, consumers should contact their local social security office or go to https://www.ssa.gov/ to create an account and enroll. Consumers who postpone enrolling into their Medicare Part A and/or Part B will have a general election period to start their original Medicare from January 1st-March 31st, but your coverage will not begin until July 1st and you may have to pay higher premium rates due to the late enrollment.

When is Medicare Open Enrollment?

Annually there is a Medicare Open enrollment period for recipients to change their Medicare Advantage plans or their Medicare Part D plan. The annual open enrollment will operate from October 15th-December 7th and the coverage changes will take effect starting January 1st of the following year.

Do you still have employer coverage at 65?

Individuals who are covered by an Employer's group health plan (whether it is your employer or your spouse's employer) you can sign-up for Part A and Part B through a special enrollment period without a penalty. This special enrollment period may be used anytime you're still covered by the group health plan after you turn 65, but you may want to explore how this change in health insurance may affect you and your family. This special enrollment period will also be effective for the first 8 months starting when your employment or health coverage ends, whichever happens first.

Medicare can be a confusing new landscape to explore, but there are people who can help you. Due to the demand in our community Ohio Hills Health Services (OHHS) partnered with Ohio Senior Health Insurance Information Program (OSHIIP) to offer free Certified Medicare Counselor's to help answer your Medicare questions and offer this assistance to anyone in the community, not just OHHS patients.

How can I receive Medicare counseling?

  • Ohio Senior Health Insurance Information Program (OSHIIP): 1-800-686-1578
  • In-Person Assistance from Ohio Hills Health Services OSHIIP Volunteers:

Brandy Stephens

[email protected]

Call: 1-740-239-OHHS (6447) Ex.1023

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Do you know what to consider when choosing any type of health insurance plan? 

  1. Did you list all the doctors that your family receives services from? Did you find out if all your doctors are in-network?
  2. What are the selection of specialists you must choose from? Who are in network? How far away are the specialists?
  3. What hospitals would your family attend if they need testing or surgery? What about an emergency? Are the hospitals in or out of the insurance network?
  4. Are your pharmacy preferences in-network? Are your medications on the drug formulary? What tier are the medications classified? Are your medications a preferred or nonpreferred brand?
  5. What are the plan's total costs? Did you count the Premiums + Deductibles + Co-Payments + Co-Insurance = AFFORDABILITY?
  6. Will the plan pay any amount for care from providers outside the network?
  7. Do you need any extra services such as eye or dental? Will your plan cover any of those extra expenses?
  8. Will your plan of choice cover any services when you are away from home? Do you travel a lot or stay with family/friends different times throughout the year? What about your college age children, are they covered when they are at school?
  9. How does this plan compare to other plans that may be available? Is this the best option for my family?

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What are Community Healthcare Centers?

Ohio Hills Health Services (OHHS) is a Federally Qualified Health Center (FQHC) that provides primary health care services, dental services, and case management services to area citizens, regardless of ability to pay. OHHS has been in operation in Southeastern Ohio since 1976. Since then, OHHS has expanded and open Health Centers in Woodsfield, OH, Barnesville, OH, Quaker City, OH, and Freeport, OH. OHHS also has a dental center at the Freeport Family Health Center.

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What geographic area does OHHS serve?

OHHS serves patients from all areas, regardless of their address. Most patients served, however, reside in six site counties, Belmont, Harrison, Monroe, Noble, Guernsey, and Tuscarawas.

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What is the OHHS mission?

OHHS is a non-profit health care operation, organized by communities in Eastern Ohio to promote healthy lifestyles and to provide comprehensive treatment and preventative services for area residents. The primary focus is to provide prompt, courteous and affordable health care that is responsive and sensitive to individual needs.

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What does FQHC mean?

Federally Qualified Health Centers, like OHHS receive federal grants through the Health Resources and Service Administration and/or other Federal programs to offset costs involved in providing health care to individuals that qualify.

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Who owns and operates OHHS?

OHHS is an independent, private, not-for-profit community health care center governed by a volunteer board of directors. It is managed by a Chief Executive Officer, Chief Financial Officer, Chief Operations Officer, Chief Medical Director, and Dental Director.

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What Does “primary health care” mean?

This care is provided in our ambulatory care clinic (physicians’ office). These services include (not are not limited to): acute care visits for sudden or unexpected illness (colds, flu allergies, rashes, etc.); well-child check-ups and immunizations; adult annual physical examinations and immunizations, including recommended annual breast exams and paps for women and referrals for mammograms; on-site laboratory and x-ray services; employment physicals; employee drug screenings for area industry and businesses, and general dentistry.

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Can I get medical care if I have a chronic disease?

Yes. The Center’s specialized with chronic disease and patients should plan their medical visits on a regular basis, develop and monitor self-management goals, and receive specialized counseling and education.

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Who provides the care?

OHHS is staffed with family practice physicians, internal medicine physicians,  nurse practitioners, physician assistants, case managers, general dentists, and dental hygienists. These providers have many combined years of health care experience. They are supported by a wonderful team of nurses, medical assistants, lab technicians, x-ray technicians, dental assistants, and office personnel.

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Is anyone available to talk with me after hours?

A medical provider is always “on-call” after business hours, on weekends and holidays for emergency situations. During these times you may access the answering service by calling the Center’s main number.

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Will the Center accept my insurance coverage?

OHHS accepts patients with or without insurance coverage. We accept Medicare, Medicaid and most all private insurance plans.

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If I have medical insurance, am I responsible for any copays and/or deductibles?

Most insurance plans require the patient to pay a deductible. However, Medicare patients do not have to meet an annual deductible for physicians’ visits at Community Healthcare Centers because it is a Federally Qualified Health Center. Other OHHS Services provided to a Medicare patient under Part B (lab, x-ray, etc.) will have the standard deductible as required by Medicare.

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If I’m uninsured can I get help paying for my doctor’s or dentist’s appointment?

OHHS has a sliding-fee scale for individuals who quality. You will need to talk with a receptionist at the time of your appointment to obtain an application.

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Can I get any help paying for my prescription medicines?

OHHS can help in two ways:

Please ask your provider for information at your visit if you need assistance:

1. Certain prescription medicines are obtained at a very low cost to the patient;

2. OHHS participates in the 340 B prescription assistance program.

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