Atención médica. Es fácil.

La forma en la que se ofrece cobertura para la atención médica ha cambiado en los últimos años. Esta guía de Blue Cross and Blue Shield of Texas (BCBSTX), una división de Health Care Service Corporation, puede ayudarte a evitar confusiones y responderá a muchas de tus preguntas. Se trata de Atención médica. Es fácil.

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    Lo básico sobre cobertura médica

Puntos básicos

  • Casi todos los estadounidenses ahora deben tener cobertura médica.

  • Aquellos que no tengan cobertura podrían recibir una multa sobre impuestos que continuará siendo más alta cada año.

  • Cualquier persona que sea elegible puede obtener cobertura médica sin importar su edad, género o padecimientos preexistentes.

  • Muchas personas recibirán ayuda financiera para pagar por su cobertura. En el 2016, un 84% de los inscritos en el Mercado de Seguros Médicos en línea en Texas fueron elegibles para recibir ayuda financiera.

Casi todos los planes de cobertura médica incluyen los siguientes Beneficios esenciales de salud

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  • Medicamentos recetados
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    Hospitalizaciones
  • Atención médica durante la maternidad y para recién nacidos
  • Servicios y aparatos de rehabilitación
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    Servicios para pacientes ambulatorios
  • Servicios de laboratorio
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    Tratamientos de salud mental/por abuso de sustancias
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    Servicios preventivos y de bienestar
  • Manejo de enfermedades crónicas
  • Servicios pediátricos

No esperes más

Dic
15
  • El Período de inscripción abierta para inscribirse en cobertura médica empieza el 1° de noviembre del 2016.
  • Tendrás hasta del 15 de diciembre del 2016 para inscribirte y tener cobertura a partir del 1° de enero del 2017.
Ene
31
  • Para evitar una multa sobre impuestos, tienes que inscribirte y obtener cobertura médica antes del 31 de enero del 2017.

Términos importantes


  • Intercambio:
    También se le conoce como Mercado de Seguros Médicos en línea en Texas y es donde puedes informarte, comparar y comprar cobertura médica cada año durante el Período de inscripción abierta. Puedes acceder a este sitio en línea o por teléfono. En este sitio, puedes comparar los planes de cobertura médica que se ofrecen en tu área.
  • Mandato para individuos:
    Esta es la sección de la ley del cuidado de salud que requiere que la mayoría de los estadounidenses obtengan y mantengan cobertura médica.
  • Créditos sobre impuestos:
    Para ayudar a que las personas tengan cobertura médica a su alcance, aquellos que sean elegibles recibirán créditos sobre impuestos para ayudar a reducir los costos mensuales de las primas por cobertura médica. Los créditos sobre impuestos por lo general se llaman Créditos sobre Impuestos por Adelantado para Primas (APTC por sus siglas en inglés), o Créditos sobre Impuestos para la Prima.
  • Subsidio (Subsidy):
    Ayuda financiera del gobierno para las personas y familias con ingresos de hasta cuatro veces el índice de pobreza según el gobierno federal para ayudarles a comprar su cobertura a través del Mercado de Seguros Médicos en línea. Esta ayuda se proporciona como un crédito sobre impuestos.

Cuánto cuesta

Compartir: Sección
Mantente al día
  • 1:26

    Cómo ahorrar en gastos de cobertura médica

  • 1:53

    Multas sobre impuestos

Quedarse sin cobertura médica no vale la pena. Si no tienes cobertura médica existe la probabilidad de:

  • Recibir una multa sobre impuestos más alta de $695 o equivalente al 2.5% de tus ingresos, la cantidad que sea más alta. Por ejemplo, si tienes un salario de $40,000, podrías tener que pagar una multa de $1,000. Y estas multas crecen cada año.
  • Incurrir en gastos médicos inesperados si te enfermas o lastimas. Esto podría afectar tus finanzas por muchos años.

Las familias generalmente invierten entre un 6% y un 10% de su salario anual en costos relacionados con servicios de salud.

¿Eres elegible para acceder a costos más bajos?

84%
de los inscritos fueron elegibles para recibir ayuda financiera

En el 2016, 84% de los inscritos en el Mercado de Seguros Médicos en línea en Texas fueron elegibles para recibir ayuda financiera para ayudar a pagar por su cobertura.

Entender el costo real de tu cobertura de salud puede resultar complicado. Para ayudarte a averiguar si eres elegible para obtener cobertura médica a costos más bajos, nuestra calculadora toma en cuenta tus ingresos y el número de dependientes en tu familia para determinar si eres elegible para recibir subsidios federales.

Salario
anual estimado

Número de miembros
en tu familia

No

¿Eres elegible para acceder a primas más bajas con un plan de cobertura del Mercado Médico?

¡Buenas noticias! Podrías ser elegible para un subsidio de cobertura médica. Utiliza nuestra calculadora para determinar el crédito sobre impuestos y así averiguar cuánto podrías recibir.

Parece que no podrías ser elegible para recibir un subsidio para un plan médico. Sin embargo, puedes utilizar nuestra calculadora para determinar el crédito sobre impuestos o visitar cuidadodesalud.gov y así obtener más información.

calculadora
$1,250

Basado en tus ingresos, tu posible multa sobre impuestos podría ser de:

Averigua si eres elegible para recibir ayuda federal con nuestra calculadora para determinar el crédito sobre impuestos

Términos importantes


  • Coseguro (Coinsurance):
    Porción que te corresponde pagar por servicios de atención médica cubiertos por tu plan. Generalmente es un porcentaje de un gasto médico elegible.
  • Copago (Copay):
    Cantidad fija que tú pagas por servicios de salud cubiertos, por lo general al momento de recibir los servicios.
  • Deducible (Deductible):
    Cantidad que debes pagar por servicios médicos cubiertos antes de que tu cobertura médica empiece a pagar.
  • Prima del plan (Premium):
    Cantidad que se debe pagar por tu plan de cobertura médica. Usualmente se paga mensualmente.
  • Gastos de bolsillo (Out-of-pocket costs):
    Cualquier cantidad que tengas que pagar, además de tu prima mensual, es considerada un gasto de bolsillo. Tu copago y deducible son gastos de bolsillo, pero que conoces de antemano. Para algunos servicios puede aplicarse un coseguro. Si consultas con un doctor, acudes a un hospital o a una farmacia que no sean parte de la red HMO, podrías incurrir en muchos gastos de bolsillo inesperados.
  • Gasto maximo de bolsillo (Out-of-pocket maximum):
    Tu plan médico establece un límite máximo de gastos de bolsillo por atención médica cuando acudas con proveedores de la red. Esta es la cantidad máxima que pagarás de tu bolsillo cada año, la cual te protegerá en caso de que tengas algún padecimiento médico grave o costoso.

mo empezar

Compartir: Sección
Mantente al día
  • 3:25

    Cómo inscribirte para obtener cobertura médica

Lo que necesitarás para inscribirte

  • Comprobante de ciudadanía o residencia legal de EE. UU.
  • Comprobante de residencia en el estado de Texas
  • Copias de tus declaraciones de impuestos
  • Salario de todos los miembros de la familia
  • Método de pago

Cuánta cobertura necesitas

Al igual que cuando haces una compra fuerte, debes prepararte antes de comprar cobertura médica:

  • ¿Tienes previsto que tú y tu familia requieran mucha atención médica en 2017?
  • ¿Con qué frecuencia acudes a consultar con tu médico?
  • ¿Estás tomando medicamentos recetados?
  • ¿Tienes planes de tener más familia?
  • ¿También necesitas cobertura dental?

Todas estas preguntas deberían de ser consideradas cuando estés calculando cuánta cobertura necesitarías.

Fechas importantes

  • Nov
    1
    1° de noviembre del 2016
    Empieza el Período de inscripción abierta para planes disponibles en 2017
  • Dic
    15
    15 de diciembre del 2016
    Último día para inscribirse y tener cobertura a partir del 1° de enero del 2017
  • Ene
    15
    15 de enero
    del 2017
    Último día para inscribirse y tener cobertura a partir del 1° de febrero del 2017
  • Ene
    31
    31 de enero del 2017
    Acaba el Período de inscripción abierta

Términos importantes


  • Dentro de la red (In-network):
    Doctores y otros proveedores de servicios de salud que participan en la red del plan de cobertura médica.
  • Médico de atencion primaria (PCP):
    Tu médico de cabecera, quién coordina tu atención médica, centrada en un estilo de vida saludable y en la prevención de enfermedades.
  • Punto de servicio (Point of Service):
    Los beneficios de Punto de servicio o POS en inglés, proveen cierto nivel de cobertura cuando acudes con un proveedor de salud fuera de la red médica del plan, pero incurrirías en gastos de bolsillo más altos. Tú decides si prefieres utilizar tu red o recibir atención fuera de tu red y pagar más. No todos los planes médicos ofrecen beneficios de Punto de servicio.

Atención médica. Es fácil.

Compartir: Sección
Mantente al día
  • 1:34

    Maneja tu cobertura médica con planes HMO

  • 1:28

    Un médico de atención primaria te ayudará a personalizar tus cuidados

Planes HMO: Atención médica. Es fácil.

Los proveedores de cobertura médica proporcionan acceso a beneficios de atención médica. Manejar la atención médica con un plan HMO hace que tu cuidado de salud sea sencillo.

Los planes HMO tienen precios basados en una red de doctores y hospitales disponibles en el área en la que vives. Esto resulta en primas más bajas en comparación con otros planes con redes más amplias.

¿Necesitas ayuda para entender un plan HMO? Esta página puede ayudarte.


Qué recibes de un plan HMO

  • Calidad
    Generalmente, los planes HMO ofrecen primas mensuales más bajas que otros tipos de planes médicos.
  • Atención personalizada
    Esto significa que tendrás un doctor que conoce tu historial médico y que coordinará tu atención médica dentro de la red de tu plan para ayudarte a que tengas acceso a la atención médica y a los programas de bienestar que necesites.
  • Confiabilidad
    Tu médico de atención primaria (PCP) te ayudará a que recibas la atención que necesites cuando la necesites y te encamina en la dirección apropiada. Además, tu proveedor de cobertura médica será tu guía con información sobre los proveedores que forman parte de la red del plan y con personal de apoyo médico para que ayuden por si tienes algún padecimiento médico grave.

Elige el plan apropiado para ti

  • Bronce

    Costos mensuales más bajos, pero gastos de bolsillo más altos

    Por lo general, el plan paga el 60% y el asegurado el 40%

  • Plata

    Costos mensuales y gastos de bolsillo promedio

    Por lo general, el plan paga el 70% y el asegurado el 30%

  • Oro

    Costos mensuales más altos, pero gastos de bolsillo más bajos

    Por lo general, el plan paga el 80% y el asegurado el 20%

Términos importantes


  • Plan HMO (HMO):
    Los planes de Organizaciones para el Mantenimiento de la Salud o HMO en inglés usualmente ofrecen primas más bajas. Tu médico de atención primaria (PCP) coordina la atención médica que necesites, de ser necesario te da referidos para que consultes con otros médicos y se centra en la prevención de enfermedades, no solo en brindar tratamiento médico.
  • Gastos de bolsillo (Out-of-pocket costs):
    Cualquier cantidad que tengas que pagar, además de tu prima mensual, es considerada un gasto de bolsillo. Tu copago y deducible son gastos de bolsillo, pero que conoces de antemano. Para algunos servicios puede aplicarse un coseguro. Si consultas con un doctor, acudes a un hospital o a una farmacia que no sean parte de la red HMO, podrías incurrir en muchos gastos de bolsillo inesperados.
  • Gasto maximo de bolsillo (Maximum):
    Tu plan médico establece un límite máximo de gastos de bolsillo por atención médica cuando acudas con proveedores de la red. Esta es la cantidad máxima que pagarás de tu bolsillo cada año, la cual te protegerá en caso de que tengas algún padecimiento médico grave o costoso.
  • Dentro de la red:
    Doctores y otros proveedores de servicios de salud que participan en la red de tu plan de cobertura médica.
  • Medico de atencion primaria (PCP):
    Tu médico de cabecera. Con un plan HMO, te asocias con un médico de atención primaria, centrado en un estilo de vida saludable y en la prevención de enfermedades. Tu médico de atención primaria coordina toda tu atención médica, incluyendo hospitalizaciones y referidos para consultar especialistas.
  • Punto de servicio (Point of Service):
    Los beneficios de Punto de servicio o POS en inglés, proveen cierto nivel de cobertura cuando acudes con un proveedor de salud fuera de la red médica de tu plan HMO, pero incurrirías en gastos de bolsillo más altos. Tú decides si prefieres utilizar tu red o recibir atención fuera de tu red y pagar más. No todos los planes médicos HMO ofrecen beneficios de Punto de servicio.