This document provides an overview of Obamacare and how to navigate health insurance. It explains what health insurance is, different plan types like Medicaid and private insurance, key terms like premiums and deductibles. It also outlines how to find a provider, access care, and maintain health coverage on an ongoing basis. The presentation aims to help new enrollees understand and make the most of their health plan benefits.

1. OBAMACARE 101
PRESENTED BY HEARTLAND HEALTH CENTERS

2. YOU’VE ENROLLED, NOW WHAT?
CONGRATULATIONS!
- Improving Your Health
- Enhancing your Quality of Life
- Better prepared for the unexpected
QUESTIONS WE’LL ANSWER
- What is Health Care?
- What is Primary & Preventive Care
- What is Insurance & How Does It Work
- Your Role

3. YOU & YOUR HEALTH
Having Health Care helps you to:
Maintain a healthy lifestyle at home, at work, and in the
community.
Stay on top of your health and get your recommended
health screenings and manage chronic conditions.
Keep all of your health information in one place.

4. HEALTH INSURANCE
• HEALTHCARE: Provides financial protection against the high costs
of medical care in case of serious illness or injury.
Research the
policy/plan
that works
best for you
Select the
plan/policy
best for you
Pay the
premium for
the policy you
selected
Insurance
Plan issues
and defines
coverage
Insurance
company pays
for a medical
necessary
claim

5. YOUR PLAN
• All of the plans, cover important things like doctor visits,
hospital stays, prescriptions and more.

6. UNDERSTANDING YOUR HEALTH COVERAGE
• Identify what insurance plan you have, Medicaid or Private
Insurance
• Check to see what services are covered,
• Know the Difference between In-network vs. Out-of-Network
• Learn the costs (Premiums, Copayments, Deductibles,

7. INSURANCE PLAN TYPES
MEDICAID
 Medicaid is a jointly funded State and Federal government program that pays for medically
necessary services for qualified persons. In Illinois, it is managed by 2 agencies: The Illinois
Department of Healthcare & Family Services and The Illinois Department of Human Services
through offices called Family Community Resource Centers (FCRC).
PRIVATE INSURANCE

8. DEFINITIONS
• DEDUCTIBLES: Amount that you pay before an insurance policy provides
coverage.
• PREMIUMS: Amount that must be paid for your health insurance or plan.
You and/or your employers usally pay it monthly, quarterly, or yearly.
• COINSURANCE: Percentage (%) that the patient pays for covered services
after the deductible has been met.
• COPAYMENTS: Small, specific amount of money paid at the time you
receive service i.e. Doctor’s visits, emergency room, urgent care or
prescription drugs. Does not apply to your deductible.
• OUT OF POCKET LIMIT: Total sum of expenses you may pay in any given
calendar year for essential benefit services you receive. Your monthly
premium is not included.

9. IN NETWORK VS. OUT-OF-NETWORK
• IN-NETWORK: Uses a set of preselected doctors and
specialists.
• OUT-OF-NETWORK: Using services outside of your
selected doctors and specialists. Costs are usually higher
when using doctors and specialists outside of your
network

10. FINDING YOUR PROVIDER
• Ask people you trust and/or do research on the internet.
• Check your plan’s list of providers.
• If you want to change your current provider, contact your
insurance plan provider.

11. MANAGED CARE
• Managed Care is a means to deliver the best healthcare in the
most cost effective way possible.
HMO
• Health
Maintenance
Organization
• Copays,
Coinsurance, Out-
of-Pocket Limits
PPO
• Preferred
Provider
Organizations
• Deductible,
Coinsurance, Out-
of-Pocket Limits
POS
• Point of Service
Organization
• Copayments,
Coinsurance,
Deductibles

12. HOW TO ACCESS YOUR CARE
• You may choose your current medical provider if they are enrollled with Illinois
Department of Healthcare and Family Services (HFS).
• For help finding a provider, call Illinois Health Connect at 877-912-1999,
TTY:866-565-8577.
• Call your local DHS Family Community Resource Center
• DHS Bureau of Customer Inquiry & Assistance
• Monday- Friday (except State Holidays)
• 8:30a – 5p.m.
• 800-843-6154
• HFS Health Benefits Hotline
• Monday – Friday (except state holidays)
• 8a – 5p.m.
• 800-226
• For Marketplace Questions, call 800-318-2596 or visit www.healthcare.gov.

13. WHERE TO GO FOR SERVICE
• EMERGENCY ROOM: Use for life threatening situations ONLY.
• YOUR PHYSICIAN: Your doctor is where you go to get your
primary care services like your annual check ups and
screenings.
• Call Your Doctor to set up an appointment and identify if you are a “new” or “existing
patient.”
• Give the name of your insurance plan and make sure they accept your insurance.
• Let them know the name of the provider you want to see and the reason for the
appointment.
• Select a day and time frame.
• Make your appointment and keep it.
• It’s important to know the difference between primary care
and emergency care.

14. PREPARING FOR THE VISIT
• Have your insurance card with you.
• Know your family health history and make a list of any medicines
you take.
• Bring a list of questions and things to discuss, and take notes
during your visit.
• Bring someone with you to help if you need it.

15. DEVELOPING YOUR RELATIONSHIP
• Feel out your provider. Are you comfortable with your provider?
• Were you able to communicate with and understand your provider?
• Did you feel like you and your provider could make good decisions together?
If NO, you can always change your provider. Remember: it is okay to change to a
different provider!
If YES, GREAT! Continue to follow up and follow the instructions given by your
provider.

16. AFTER YOUR APPOINTMENT
• Follow your provider’s instructions.
• Fill any prescriptions you were given, and take as directed.
• Schedule a follow-up visit if you need one.
• Review your explanation of benefits and pay your medical bills.
• Contact your provider, health plan, or the state with any
questions, comments or concerns

17. KEEP YOUR COVERAGE
• Maintain your appointments with your caseworker.
• Report changes to your income, marital status, or
employment.
• Keep up with Open Enrollment & Special Enrollment
Periods.

18. FOR MORE INFORMATION
SE
• Speak with a Heartland Health Center Certified Application or In Person
Counselor at 773.296.5580.
Visit us at Heartland Health Centers
845 W. Wilson Ave
Chicago, Il 60640
Mondays & Wednesdays
10am- 4pm
No Appointment Necessary!