Yes. By law, all ACA plans cover preexisting conditions, with no annual or lifetime limits.
The annual Open Enrollment Period for individual and family plans varies by state.
Anyone who qualifies for an ACA plan may enroll during this time period.
When you experience a major life event — like the birth of a child, the loss of a job, or a move to a new ZIP code — you may qualify for a Special Enrollment Period (SEP). An SEP typically gives you a 60-day window to enroll in a new individual or family plan and may occur at any time throughout the year.
All Highmark ACA plans cover the 10 Essential Health Benefits:
Some Highmark ACA plans include optional adult dental and vision coverage. All ACA plans include pediatric dental and vision coverage.
Find in-network doctors, hospitals, labs, mental health professionals, diagnostic and imaging centers, medical supplies and service partners, urgent care and retail clinics, and other health care services here
This will depend on the plan you select. Every plan comes with a formulary: a list of prescriptions covered by your health plan.
Yes. Mental health services are covered as one of the 10 Essential Health Benefits.
Yes. Substance use disorder services are covered as one of the 10 Essential Health Benefits.
*Only a requirement for purchasing plans on the marketplace. There is no citizenship requirement for purchasing plans directly though Highmark or other health insurance companies.
Depending on the life event that qualifies you for an SEP, you may need documentation like:
You may need to provide documentation for each person in your household verifying:
The annual Open Enrollment Period for individual and family plans varies by state.
Anyone who qualifies for an ACA plan may enroll during this time period.
When you experience a major life event — like the birth of a child, the loss of a job, or a move to a new ZIP code — you may qualify for a Special Enrollment Period (SEP). An SEP typically gives you a 60-day window to enroll in a new individual or family plan and may occur at any time throughout the year.
You can purchase individual or family ACA plans via:
APTCs and CSRs will only apply to plans bought through the marketplace.
APTCs and CSRs are also known as subsidies. These are tax credits that get applied directly to your premium or out-of-pocket costs.
Visit highmark.healthsherpa.com to see if you qualify for financial assistance. Your household size and annual income will help determine eligibility.
If you're happy with your plan and don't want to make changes, you don't have to do anything. Most plans auto-renew at the Open Enrollment deadline.
