Frequently Asked Questions
Why should I have health coverage? Many of us do not think about health care until we need it. However, health care is important at all times – for preventative care and for unexpected emergencies. Also, with the new health law (the Affordable Care act, also known as Obamacare), everyone is required to have health insurance. What happens if I do not have health insurance? Everyone must have health insurance. If someone can afford health insurance but is uninsured, they may be subject to a penalty fee. They must also pay for all of their care. What is the penalty fee and how would it affect me? The penalty fee for not having health insurance coverage is calculated in one of two ways. If you (or any dependents) do not have health insurance coverage that qualifies, you will pay either a percentage of your household income or a flat fee - whichever is higher.
If you don't have coverage in 2015, you'll pay the higher of these two amounts:
- 2% of your yearly household income (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty)
- $325 per person for the year ($162.50 per child under age 18). The maximum penalty per family using the method is $975.
If you don’t have coverage in 2016, you’ll pay the higher of these two amounts:
- 2.5% of your yearly household income
- $695 per person ($347.50 per child under 18)
What if I have a pre-existing medical condition? Health plans in the Marketplace cannot deny health insurance coverage because of a medical condition you had before signing up for coverage. Coverage for any pre-existing medical condition you may have begins the effective date of your coverage. When is Open Enrollment? Open enrollment for 2015 ended on February 15, 2015. Individuals may qualify for enrollment outside of Open Enrollment, through a Special Enrollment Period.
Open enrollment for 2016 is November 1, 2015 through January 31, 2016
What is a Special Enrollment Period Conditions that qualify for a Special Enrollment Period include the following life events. Contact the Health Insurance Exchange in your state if any of the following conditions impact you, or you need additional clarification:
- Not aware of penalty for not having health insurance (specific dates apply)
- Getting Married or divorced
- Have a child, adopt a child, or place a child for adoption
- Have a change in income
- Get Health coverage thorough a job or a program like Medicare or Medicaid
- Change your place of residence
- Have a change in disability status
- Gain or lose a dependent
- Become pregnant
- Experience other changes that may affect your income and household size
As a new member, when will my coverage start?
- If You applied on or before December 15, 2015, the Effective Date of Your coverage is January 1, 2016.
- If You applied between December 16, 2015 and January 15, 2016, the Effective Date of Your coverage is February 1, 2016. If You applied from January 16, 2016 through January 31, 2016, the Effective Date of Your coverage is March 1, 2016.
- You must be eligible under the special enrollment procedures established by the Marketplace and/or Molina. In such case, the Effective Date of coverage will be determined by the Marketplace. The Marketplace and Molina will provide special monthly enrollment periods for eligible American Indians or Alaska Natives.
When will I receive my Molina ID card? Within 10 days after you pay your first premium. For coverage starting on the first of the month we will send out ID cards approximately the 26th of the month.
How can I learn more about insurance coverage with Molina? Check out our Molina Marketplace Plans and other important Molina Marketplace information here. Or, simply call us at (855) 882-3898 to learn more. We can help you understand the right Molina plan options for you and your family.
Can I set up an auto-payment? Yes, just call the Customer Support number located here. What types of payment are accepted for auto-payments? Electronic Funds Transfer, checking account, or credit card by calling the customer service number located here. When will my auto-payment be taken from my account? On the 23rd of every month. Can I set up an auto-payment for a portion of my premium more often than once a month? We only accept payments in full one time per month. I have not received an invoice. How do I find out what I owe Molina? Please register and/or sign into your My Molina account to find out your balance, or call the customer support number located here.
- Provider and Pharmacy Network
When can I select a Provider after I enroll in a Molina plan? After you enroll, we will send you a letter asking you to inform us of your PCP. How do I select a Primary Care Provider? Upon enrolling, you will be asked to select a Participating Primary Care Provider for you and for any family members. How do I know which doctors I can see? To determine who might be best for you, go to the Provider Online Directory. Is my Pharmacy in your network? Molina participates with CVS Caremark Pharmacies. You will need to determine if your pharmacy is within our participating list of pharmacies by going to the online Pharmacy locator. Will my prescription drug be covered? You can search for whether your prescription drug is covered by Molina by going to the online Formulary (drug list).
- Member Services
I enrolled in a Molina plan. When can I register on the "My Molina" Member portal to see my benefits and services? You can register on the My Molina Member Portal within a week after enrollment.