An animated figure stands waving into the camera. More figures appear in a trio of bubbles around the first figure. Animated arms shake hands. An animated navy blue caduceus appears on a blue background. Blue and white text winds around it. A map of California appears above an animated computer monitor and white text.
Maps of Minnesota and then New York replace California. An animated figure waves at the camera. A question mark appears over its head as the camera pans out to reveal lots of other figures standing alone or in clusters around the first, all with question marks over their heads. The question marks above the figures' heads spin and turn into blue, green, or yellow dots. Others may purchase coverage directly from health insurers. And still others may have coverage through their employer. Blue text appears on a yellow background.
Subsidies are only available in the individual marketplaces.
NARRATOR: Marketplaces exist in each state and are operated by either the state government, by the federal government, or as a partnership between the two. An animated figure waves at the camera as a triangular arrow spins slowly over its head.
They help consumers understand and explore their insurance choices and enroll in a health plan. Animated figures stand alone or in clusters on a purple background. They wave. A magnifying glass enlarges one figure as it waves. NARRATOR: As many small business owners, individuals, and families consider their options, they're looking to brokers for guidance in what can feel like complicated new territory.
P, a government program. Dad has insurance through his employer, but Mom is uninsured. Green can use a marketplace to find a plan that meets her needs. A broker can help her select and purchase coverage, whether through marketplaces or directly from a health insurer. Under the Act, many additional families and individuals may qualify for Federal Subsidy Assistance. These subsidies will help reduce costs. NARRATOR: To qualify for a subsidy, individuals or families must: buy insurance through the individual marketplaces, meet household income requirements, not have affordable health insurance available through an employer, and not be eligible for Medicaid, Medicare, or other government programs.
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Two figures stand in front of a storefront. Speech bubbles appear and disappear in front of each figure. Brokers can help small business owners understand their options and choose a plan that best meets their budget and needs, whether it's from the SHOP or the traditional commercial market. After helping an employer understand the options available The camera pans left to reveal a cluster of figures standing near the first two.
Speech bubbles appear near a couple figures. Subsidies are not available to employees who get their insurance through SHOP, but employers may pay a portion of their employees' health insurance premiums to lower their employees' costs. It's important for both employers and individuals to know that if they purchase health insurance through the marketplaces that the marketplaces, not the insurer, are the source for answers to questions related to eligibility and enrollment. A figure stands at the confluence of three paths stemming from buildings emblazoned with letters.
Some marketplaces may choose to let health insurers and brokers work together as they do today. Others may choose to distribute the broker fees, and some may set the broker fees. For marketplaces operated by the state, check the state's website for any certification requirements. The animated UnitedHealthcare building reappears.
Animated figures appear on the ground below and around the building. What are some types of coverage rules? If it is not approved, the plan will not cover the drug. For example, the plan provides 60 pills in 30 days for some drugs.
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After the first drug is tried, the plan will then cover the other drug for that same condition. The plan may not cover Drug B unless you try Drug A first.
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If Drug A does not work for you, then Drug B will be covered. First, please call your doctor and ask if your drug is covered. Your doctor can ask the plan to cover your drug through the prior approval process. What are generic drugs? Aetna Better Health covers both brand and generic drugs. The plan will cover OTC drugs on the formulary. Some OTC drugs may have coverage rules. Most OTC drugs need a prescription from a doctor if they are to be covered by the plan. Aetna Better Health ofrece cobertura para los medicamentos de esta lista.
Es posible que para algunos medicamentos se apliquen reglas de cobertura. El plan puede agregar o quitar medicamentos de la lista. Por ejemplo, los medicamentos que se usan para tratar un dolor de oído figuran en la sección, Ear-Nose-Throat Medications. Si sabe para qué se usa el medicamento que usted toma, busque el nombre de esa sección en la lista de medicamentos y luego busque el medicamento en esa sección. Usted no tiene que pagar por los medicamentos cubiertos. Límites de cantidad QLL : significa que el plan cubre hasta una cierta cantidad del medicamento.
Por ejemplo, en el caso de algunos medicamentos, el plan cubre 60 píldoras en 30 días. Por ejemplo, el Medicamento A y el Medicamento B pueden tratar su condición. Es posible que el plan no cubra el Medicamento B a menos que usted primero pruebe el Medicamento A.
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Su médico puede solicitar que el plan cubra el medicamento a través del proceso de aprobación previa.