Tag Archives: Affordable Care Act

Children's Preventive Care

Your Children’s Preventive Care and Physicals

Getting your kids to their physicals and checkups, where they can get covered children’s preventive care and screenings, helps them be their healthiest. It’s important not only that you know what’s recommended for their ages and what they need to stay up to date, but also that you get them to the doctor for this on the right schedule.

What Happens at Their Physical

Your child needs to have regular wellness visits with their doctor to focus on their development, health, and wellness. At the appointment, some of the basics your doctor will cover are:

  • Checking that your child is developing at a healthy rate and tracking their health information and history
  • Getting a physical exam
  • Staying up to date with their preventive care
  • Getting education and counseling
  • If needed, setting health goals

Visit Schedule

Your baby needs to go to well-baby visits at:

  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old

Children need to visit their doctor at:

Adolescents and teens should visit the doctor at least once a year:

Choose a visit from the lists above to learn more about what will happen at that visit.

Children’s Preventive Care

Certain children’s preventive care and screenings are always covered, depending on timing and what your doctor recommends.


  • Gonorrhea preventive medication
  • Hearing screening
  • Hemoglobinopathies or sickle cell screening
  • Hypothyroidism screening
  • Phenylketonuria (PKU) screening

Babies and Small Children

0 to 11 months
  • Behavioral assessment
  • Blood pressure screening
  • Height, weight, and body mass index (BMI) measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment
  • Iron supplements for children ages 6 to 12 months at risk for anemia


1 to 4 years
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Autism screening for children at 18 and 24 months
  • Developmental screening for children under age 3
5 to 10
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment


11 to 14
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Hepatitis B screening for adolescents at high risk
  • Alcohol and drug use assessments
  • Cervical dysplasia screening for sexually active females
  • Depression screening
  • Sexually transmitted infection (STI) prevention
  • counseling and screening for adolescents at higher risk
15 to 17
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Hepatitis B screening for adolescents at high risk
  • Alcohol and drug use assessments
  • Cervical dysplasia screening for sexually active females
  • Depression screening
  • Sexually transmitted infection (STI) prevention
  • counseling and screening for adolescents at higher risk


  • Obesity screening and counseling
  • Hematocrit or hemoglobin screening
  • Lead screening for children at risk of exposure
Dental and Vision

Plans that meet the Affordable Care Act’s essential health benefits also include some vision and dental coverage:

  • Dental exam every 6 months
  • Cleanings, fluoride treatments, and X-rays
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Yearly vision screening for all children
  • Most people can get help with their child’s glasses or contacts on their plan too

You can also buy extra dental coverage to add to your plan for a low monthly cost.


Vaccines, or shots, are an important part of your children’s preventive care. These should be delivered on a specific schedule to make sure your kids are protected at every age. Shots that are listed more than once at different ages include multiple doses to finish the vaccine.

  • Hepatitis B
1 to 2 month
  • Hepatitis B
2, 4, and 6 months
  • Diphtheria, Tetanus, Pertussis (DTaP)
  • Haemophilus influenza type b (Hib)
  • Polio
  • Pneumococcal conjugate
  • Rotavirus
6 to 18 months
  • Hepatits B
  • Polio
  • 2 flu shots (6 months or older)
12 months and older
  • 12 to 15
    • Hib
    • Pneumococcal conjugate
    • Measles, Mumps, Rubella (MMR)
    • Varicella (Chickenpox)
  • 12 to 18
    • DTaP
  • 12 to 23
    • Hepatitis A
18 months and older
  • Hepatits A
  • Flu shot once a year
4 to 6 years
  • DTaP
  • Polio
  • MMR
  • Varicella
  • Flu shot once a year
11 to 12
  • Tdap (booster to DTaP)
  • Meningococcal A, C, W, and Y (MenACWY)
  • Human Papillomavirus (HPV) – 2 doses
  • Flu shot once a year
16 years
  • MenACWY
  • Flu shot once a year
18 years
  • Meningococcal B (MenB) – Talk to your child’s doctor to find out if they need this vaccine.
  • Flu shot once a year

Visit the Centers for Disease Control and Prevention (CDC) and enter your child’s birth date to get a customized shot schedule.

Know What’s Covered

Learn more about what immunizations are covered for your children. And log in to Your Health Alliance or search by your or your child’s member number to see what children’s preventive care your family’s plan covers.

You can use our general preventive care guidelines and prescription drugs to get an idea of what our plans cover.

If you’re not sure what’s covered and what you’ll need a preauthorization for, you can check your coverage and preauthorization lists at Your Health Alliance.

Now that you’re ready for your children’s physicals, log in to Your Health Alliance if you need to set a Primary Care Provider (PCP) for your child or start searching for doctors in our network.

SEP Changes like Moving

When Change Happens, We Can Help

Things change. We understand that the unexpected is a part of life. But there are ways we can help you get covered when the unexpected happens.

If you weren’t able to get coverage during this Annual Enrollment Period, or if something important has changed and you need a new plan, you may be able to get a Special Enrollment Period (SEP).

During an SEP, you can buy a new plan or make changes to your current plan.

To get an SEP, you need a qualifying life event (something that has changed your insurance needs). Qualifying life events include:

  • Getting Married
  • Having, adopting, or the placement of a child
  • Permanently moving to a new area offering different health plan options
  • A change in income or household status, which can change how much government help you can get
  • Losing other health coverage because of:
    • Job loss
    • Divorce
    • Loss of eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
    • Expiration of COBRA coverage
    • Your health plan no longer meets the requirements of the Affordable Care Act (ACA)
    • Reduction or termination of employer contributions
    • Significant increase in the cost of your plan

If any of these items describes your situation, you have 60 days after that event to enroll in a new plan. You can shop with us online or call us at 1-877-686-1168 for help finding a plan.

Your new coverage date will depend on the kind of life event you had and what day of the month you enroll. Learn more about when your new plan will start.

Losing your coverage doesn’t always mean you get an SEP. You can’t get one if you lose your insurance because:

    • You didn’t pay your premiums
    • You chose on your own to quit your other health coverage
    • You lost a short-term plan or (in some cases) a Catastrophic plan

If you can’t get an SEP, you can always get covered with a short-term plan at any time. While they do help with your health costs, they aren’t qualified health plans under the ACA, which means you could still have to pay a tax penalty in the next year.

Still not sure what to do in your situation? Call us at 1-877-686-1168 for help figuring out your options.

Shopping in the Marketplaces

A Different Kind of Mall

Shopping season is here! And not just for the holidays. The Open Enrollment Period (OEP) is now in full swing for you to buy health insurance too. It’s time to start comparing plans, and you should start with the marketplaces.

State Public Marketplaces

The Affordable Care Act requires each state have a Public Exchange, or Marketplace. These are like an online mall where you can compare the price and benefits of each product, much like you would with a big purchase like a television, a phone or a mattress. Only, in the exchanges, you’re comparing individuals’ health insurance plans.

Individual plans are what you shop for if you don’t have insurance through your employer and you don’t qualify for Medicare or Medicaid.

Our Private Marketplace

Health Alliance has its own Public Marketplace too. This shows you only our plans available in the Public Marketplace. You can find our plans in the state Public Marketplace too, but if you already know you would like the customer service and personal attention of Health Alliance, you can compare plans in our Public Marketplace with less clutter and confusion.

To put this in easier terms, if you know you want Levi jeans, finding what you want in a Levi jeans store will be easier than shopping in a department store. Shopping in Health Alliance’s private marketplace is no different.

Our Direct Marketplace

You can also shop for individual plans in our Direct Marketplace. It has all of our private plans, which offer more plan, doctor, and drug choices.

It is more like a specialty store that has many options, like going to Best Buy to shop for televisions. Here, you can pay more for premium features if want them, or you can find something that balances both price and benefits.

Learn more about the exchanges, or start shopping for plans at HealthAlliance.org or by calling us at 1-877-686-1168.

Shop Online for Health Insurance

New to Shopping for Health Insurance?

If you’ve never shopped for health insurance before, it can be a little scary. We are going to make the journey easier this Open Enrollment Period. Check back each week for another post that helps you shop for a Health Alliance plan.

We’ll start small – with the Open Enrollment Period.

The Open Enrollment Period (OEP) is from November 15 to February 15 this year. Each fall, the government picks a time that you can buy insurance for the next year.

What happens if you don’t enroll by February 15?

You will have to wait until the next Open Enrollment Period (fall of 2016), or have a life-changing event, like getting married or having a baby, that qualifies you for a Special Enrollment Period.

After February 15, most people will have to pay a penalty for not having a plan, and worse yet, they’ll still have to pay for 100%of their medical costs. Talk about adding insult to injury!

Can you change your plan after the OEP?

No, you would have to wait until the 2016 OEP to change plans. If you’re unhappy with your current plan, now is the time to take action!

How does the government know if you have insurance?

They’ll ask you on your taxes. Health insurance companies like Health Alliance will also turn in information to the IRS telling them who has a qualified health plan (QHP) through us.

What’s a Qualified Health Plan?

A Qualified Health Plan (QHP) is a plan that is certified by the federal Health Insurance Marketplace. That means it will include all the benefits the Affordable Care Act (ACA) requires and meets all of the spending limits and rules of the ACA.

Why should you buy health insurance instead of paying the fine?

Sometimes, especially when you’re young and healthy, it seems like paying a one-time fine could be a better deal than paying a monthly insurance premium.

But in that case, you need to weigh the risk with the money. The average hospital stay for people 18 to 44 years old is $7,400.

The average cost of a broken arm for a simple break is $2,500-$3,500. If it was bad break, it can be several times more than that.

Can you afford to pay $2,000 out-of-pocket? What about $10,000? What if you were in an accident or needed surgery, would the cost of taking care of yourself ruin you financially? When you think about it that way, the cost of health insurance is a good investment. Learn more about insurance on our website.

When you’re ready to start shopping, Health Alliance can help you. Visit HealthAlliance.org or call us at 1-877-686-1168 to learn more.

Summer Relaxing with a SEP

What’s So Special About Summer?

Didn’t buy health insurance by the deadline? Had some unexpected changes since then and need a plan, fast? A Special Enrollment Period (SEP) might be right for you. We have just what you need this summer to take a little of that heat off.

Dog Days

  1. Ice Cream
  2. Humidity More Ice Cream
  3. Getting a Special Chance to Buy Health Insurance

Every year, as summer turns to fall, and fall to winter, millions of Americans buy health insurance. During that season, the government gives everyone a chance to buy the plan they need, but by early spring, time’s up!

But here’s some good news, everyone knows the world doesn’t stop turning during the summer months. That’s why some special rules help you out when life gets interesting.

Special Enrollment Periods (SEPs) are special chances to buy or make changes to your health insurance plan the rest of the year. Here’s a quick Q&A on how they work.

Interested in signing up or need to learn more? Give us a call at 1-888-382-9771! We’re here to help.

Q:  What’s an SEP?

A: After March 31, only people with a qualifying life event can change their individual or family plan or enroll in a new plan. That’s called having an SEP.

Q: What’s a qualifying life event?

A: Events include:

  • Getting married
  • Having, adopting, or the placement of a child
  • Permanently moving to a new area with different health plan options
  • Losing other health coverage because
    • You lost your job
    • You don’t work enough hours to stay on your employer’s plan
    • Your employer stops paying for your plan or stops paying as much
    • Your plan doesn’t cover the essential health benefits as required by the Affordable Care Act (ACA)
    • A big increase in how much you pay for your plan

Q: Is a change in my income a qualifying life event?

A: For people who already have a qualified health plan, a change in income or household status can be a qualifying life event. Both of these events might change how much government help you can get to pay for your plan.

Don’t forget, you can apply for Medicaid or the Children’s Health Insurance Program (CHIP) any time.

Q: Why don’t I always qualify for an SEP if I lose my coverage?

A: Some events don’t count as a qualifying event:

  • Losing your plan because you didn’t pay your premiums
  • Choosing on your own to quit other health coverage
  • Losing coverage that’s not minimum essential coverage, like a short-term plan or (in some cases) a catastrophic plan

Q: What if I don’t have a qualifying life event?

A: You have to wait until the next Open Enrollment Period (OEP), which will begin during the fall. The government sets the start and end dates of OEP, not Health Alliance.

You can enroll in a Short-Term plan at any time. But remember, they don’t meet the requirements of the ACA for being a qualified health plan, which means you’ll have to pay a tax penalty in 2015.

Q: How long do I have to enroll in a plan after a qualifying event?

A: 60 days.

Q: How do I enroll?

A: You get to choose how you’d like to enroll. Find what works best for you, and if you need help along the way, call us at 1-888-382-9771. Or if you’re in the Champaign area, stop by our office at 206 W. Anthony Drive (near Alexander’s Steakhouse) for help!

Q: When will my coverage start?

A: Your start date depends on your qualifying event.

If you have questions about an SEP or about your situation, give us a call at 1-888-382-9771 or stop by our office—we’re more than happy to help you find the answers.


Affordable Care

Crunching Numbers for You

The Affordable Care Act is here to make health care affordable! Let’s run through some facts about the kinds of help you can get paying for your Health Alliance individual insurance plan, called premium tax credits and cost-sharing subsidies.

What’s a premium tax credit?

A premium is what you pay monthly to have insurance. A premium tax credit lowers your cost to make a plan affordable for you.

What is a cost-sharing subsidy?

A cost-sharing subsidy makes other health insurance costs affordable, like your deductible, coinsurance, and out-of-pocket max.

Who qualifies for help?

There’s a little math involved here. First, you need to know your individual or family income. If your income falls between 100% and 400% of the federal poverty level, you can get help from the government.

You can get government help if you’re…
An individual with a gross income* of $12,000-$46,000 a year
A family of four with a gross income of $24,000-$94,000 a year

*Gross income is everything you make in a year, before any taxes or deductions.

What’s the federal poverty level?

The federal poverty level depends on your family’s size. In 2013, it was $11,490 for a single adult and $23,550 for a family of four. You can make up to 4 times that amount and still get help!

How much help will I get?

Again, there’s a little math involved. A few tools online will do the math for you, or a Health Alliance rep can help find your subsidy amount. Call or stop by our Champaign location at 206 W. Anthony Drive, near Alexander’s Steakhouse—we’ll crunch the numbers for you.

How do I apply this help to my bill?

The only thing you have to do is pick a plan from the Public Marketplace. Any public plan will let you apply for government help. The government deals directly with us after you enroll to apply its help to your bill.

What can I do if I don’t qualify for help, but I still don’t have a lot of money? 

  1. Think about your individual risk. Your individual risk is the plan’s medical deductible added to the out-of-pocket max. This is the most you’ll have to pay (besides the monthly premium,) before a plan will cover 100% of your costs. What are you OK with paying if the worst were to happen?
  2. Pay attention to a plan’s deductible and out-of-pocket max. The higher your deductible and out-of-pocket max, the lower your monthly premium. Keep in mind that if you get sick or hurt, you will have to pay for all your medical costs until you meet your plan’s deductible.
  3. Call or stop by. It’s not a sign of weakness. It’s smart. When you need medical advice, you call the doctor. When you need health insurance insight, you talk to our helpful reps.
Young Invincibles Growing Up

Young Invincibles Feel the Love for Health Insurance

Young Invincibles

Young invincibles are young, healthy, independent, and don’t have a lot of cash to throw around, but, like everyone else, they need help when it comes to:

  • Understanding their options under the new health care law
  • Choosing the plan that’s best for them
  • Listening to their mother


Conventional Wisdom

All kidding aside, the conventional wisdom surrounding young invincibles in need of insurance isn’t so conventional, after all. Sure, they aren’t flocking to the exchanges in droves, but they aren’t avoiding them, either.

In fact, according to this article by Aaron Smith, co-founder and executive director of Young Invincibles, as well as this press release from his organization’s website, it seems these youngsters are signing up in numbers proportional to the overall population, and possibly even at a higher rate than their older and wiser counterparts.

So good job, Mom—it turns out you raised them right!

What’s the Deal?

This may be their first time around the health insurance block, but the appeal to reason, and their very limited budgets, is bringing youthful buyers to the table. One small car or bike accident, sports injury, or even a bad case of mono could add up to HUGE medical bills that a struggling student or first-rung employee could never afford.

While many feared the typical response to the pay premiums vs. pay a tax penalty debate would be to just pay the penalty, stats show many young invincibles can do the math:

Paying a penalty and all of their potential medical costs for a year is not a good deal.

Not so Invincible, After All

It’s important to note that young invincible isn’t a title these people gave themselves. Obviously, they’re well aware it’s a big, dangerous world out there, and the smart play is getting yourself covered.

In fact, not only are your super-smart kids signing up to protect their wallets, they’re actually signing up to protect their (gasp!) health. They’re taking advantage of subsidies to buy up from the high-deductible catastrophic plans many assumed they would purchase, and investing in more benefit-rich Silver, and even Gold and Platinum, plans.

And why wouldn’t they? With many plan premiums starting under $100 a month, it’s a small price to pay for peace of mind and financial security.

Take Good Care of My Baby

So Mom, while we know you always want to take care of your kids, maybe it’s OK to let them leave the nest. And here’s something else that might ease your mind:

We’re here to help.

Keeping your family healthy and safe is a priority for us, too. Maybe you already have our group or individual plans, or know someone else who does. After all, we’ve been helping people find plans that meet their needs and situations for over 30 years, since before most of the young invincibles were even a gleam in anyone’s eye!

We have great plans, a great network of doctors and hospitals, and great people ready to explain the options, answer questions, and find the right match for your babies, as if they were our own.

Get signed up. To learn more or shop for plans, call 1-888-382-9771, visit us online at HealthAlliance.org, or stop by our Anthony Drive location in Champaign today!