Things you should know about Individual & Family Health Insurance
Special Enrollment Opportunities Due to COVID-19 National Emergency
The new administration announced the reopening of the Marketplace for new enrollment of 2021 plans from February 15 to May 15 as part of a special enrollment opportunity due to COVID-19.
You cannot sign up at any time; If you miss open enrollment, unless you have a qualifying event, you will have to wait until open enrollment again to sign up for 2022.
There are short-term medical policies that you can buy in the meantime. But beware of plans that claim to offer you insurance that are not full coverage health plans.
When it’s time to choose, shopping for the right plan can be a daunting feat, and with the ever rising cost of insurance choosing the right plan seems impossible. Here are a few tips to help you –
- Consider not only the premium, but the total you may have to pay if you become sick or injured. Deductible’s and Copay’s add up until you reach your Max Out Of Pocket amount.
- Remember that Copay’s do not count toward your Deductible (only toward max out of pocket).
- If you really like your doctor be sure he is In Network for the plan you choose.
Know what’s available. Consumers are well advised to price out multiple plans within the tier they’re considering. Last year’s most affordable plan with the coverage you want may not be this year’s most affordable plan. So, don’t to allow yourself to be auto-enrolled in a plan until you’ve shopped around.
Subsidies can save you money on your premium and out-of-pocket expenses. ObamaCare subsidies are only available through the marketplace. There are three types of cost assistance: Premium Tax Credits to lower your premiums, Cost Sharing Reduction subsidies (if you make less than 250% of the federal poverty level, buy a silver plan!) for lower out-of-pocket costs, and Medicaid and Childrens’ Health Insurance Program (CHIP). Cost assistance subsidies are only available through your state’s health insurance marketplace and are only available during open enrollment (unless you qualify for a special enrollment period). The exceptions are Medicaid and CHIP, which can be obtained at any time of year, and Medicare, which has it’s own enrollment period.
How federal poverty levels are used to determine eligibility for reduced-cost health coverage
- Income between 100% and 400% FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
- Income below 138% FPL: If your income is below 138% FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.
- Income below 100% FPL: If your income falls below 100% FPL, you probably won’t qualify for savings on a Marketplace health insurance plan or for income-based Medicaid.
If you don’t qualify for subsidies, you may want to see your options outside of the marketplace too; in some states, some plans aren’t offered on the marketplace. We strongly suggest finding a trusted broker or agent to help you with the process of shopping outside the marketplace. There is no need to make a choice until you are ready. However, regardless of how you shop, you’ll need to obtain coverage during open enrollment in the individual market.
Can’t I buy health insurance anytime?
Unfortunately, no. If you miss the enrollment deadline for 2021, you will have to wait until the 2022 open enrollment to sign up for health insurance. The exception to this rule is if you have had a qualifying event. Some examples of qualifying events include:
- Change in marital status
- Birth or adoption of a child
- Death of a covered dependent
- Loss of eligibility status by a covered dependent
- Change in employment status that affects eligibility for coverage
- Losing or gaining healthcare coverage eligibility under Medicare or Medicaid
- Change in residence to a location outside of a healthcare plan’s service area
If you have an event, you will have 31 days to obtain health insurance.
