You need health insurance and you must have it immediately. Not Next week. Not tomorrow. But right now! What do you do, who do you call and how much will it cost? We try to give you the best advice on how to obtain healthcare as quickly as possible for the cheapest (or no) premium. There are many affordable policies available from top-rated companies. During Open Enrollment periods, and also after the OE deadline has expired, it is possible to quickly get quality medical coverage. Often, policies can be effective the next day.
You can also choose to start a medical plan on a date in the future, although generally, it should be within 45 days of the date the application is submitted. Selected states have extended open Enrollment periods, and during pandemics, often additional and extended enrollment periods are provided.
If you are self-employed and need a plan that is budget-friendly, many options are available. To keep premiums low, you may have to consider a higher deductible with increased out-of-pocket expenses. Depending upon the time of year, guaranteed benefits may be offered. The maximum deductible for an individual Marketplace (Exchange) plan is $8,700. HSA plans offer lower deductible options and tax-deferred savings on health, dental, and vision expenses. 0% coinsurance options are offered by most carriers, although 20% and 50% coinsurance options lower the premium.
If you can’t afford coverage, many state and federal programs provide immediate credits to pay a premium, or make available $0 premium plans with comprehensive benefits. Marketplace federal subsidies, Medicaid, CHIP, and additional local resources provide low-cost coverage options to millions of Americans. Medicare-eligible Seniors may also have access to plans that offer reduced costs, including for the most expensive prescription drugs.
High Deductible (HD) Plan G is the least-expensive Medicare Supplement plan offered. In most states, policies are available for less than $50 per month. Plan F (HD) plans are still offered to existing customers, but the plans is not available for new purchase.
We assume that you are not presently covered under any type of individual, employer or state-sponsored plan. Let’s also assume that you are not able to reinstate a previously-canceled policy, you’re not eligible for an SEP (Special Enrollment Period), and you are not waiting for coverage to begin through your job within the next 30 days. And of course, we base all of our recommendations with the assumption you live here in the US. If you are presently covered and your existing policy will soon be expiring, many options are available in all states.
Temporary health insurance plans are cheap, and often issued instantaneously, within hours, or during the first day the application is taken. Many companies have this specific policy in their portfolio and it’s a popular option. But pre-existing condition claims will not be paid. Also, since temporary contracts are “non-compliant” (they do not contain all 10 required essential health benefits required for Marketplace plans), coverage is not designed to be kept more than 12 months.
Plans are offered in most states, although prices, benefits, and maximum length 0f time will vary. In several states, 24-36 months of guaranteed coverage can be secured without evidence of prior insurance. A few states restrict the policy period to six months or less. It’s also possible that family members (including spouses) may have a mixture of Marketplace and short-term contracts.
If you need a policy quickly, this type of benefit is very appropriate and many major carriers (National General, Anthem, UnitedHealthcare, and Companion Life) offer plans. A typical application can be completed online in less than 20 minutes. Height/weight typically is not used in the underwriting process. Most existing conditions will not cause a denial of coverage, although history of diabetes, heart disease, or cancer will likely cause a denial. Sometimes a combination of conditions may cause some underwriting concern, along with high BMI ratios. If denied, a separate application for temporary coverage may not be accepted by another carrier.
How cheap is short-term coverage? For instance, in the Indianapolis area, a 40-year old can purchase coverage with HCC for about $58 per month. The rate reduces to about $45 for a 30-year-old. Family temporary policies are also very inexpensive. A Family of three (male and female age 30 plus one child) will pay only $119 per month with a high deductible, and about $140 with a lower deductible. Unlike Medicare Supplement plans, all family members (living in the same household) can be covered under one policy. A small application fee is common.
It is important to understand that prices will not be the same in all areas of the country, and your age will greatly determine the rate. An older individual or family will increase the premium, and adding dependents to the policy will result in a higher rate. And with most carriers, if you have smoked within the last 12 months, there will be an increase, although typically, it is not a significant rise. If you start smoking after the policy begins, it will not impact your rate or benefits. However, if another short-term carrier or Marketplace plan is selected, rates will be higher.
Are you eligible for Medicaid? You can apply and have coverage effective three months retroactive to the application date (assuming you would have qualified three months ago). You must be a US citizen and qualify for the standard residency and immigration requirements. Mandatory benefits include inpatient and outpatient hospital services, doctor and nursing facility services, family planning, lab tests, and x-rays. Optional benefits include prescription drugs, physical and occupational therapy, dental and podiatry services, hospice, and private duty nursing.
Medicaid Expansion is occurring in many states, which increases the number of eligible applicants. Here’s how it works: The Federal Poverty Level threshold is increased from 100% of household income to 133% (which becomes 138%). This results in more families able to take advantage of low (or no) premiums for their personal healthcare needs. However, if your income substantially increases, you may need to switch to a subsidized Marketplace plan. State Medicaid eligibility standards can greatly vary. For example, shown below are MAGI (Modified Adjusted Gross Income) levels for children ages 6-18 in selected states:
California – 261%
Florida – 133%
Georgia – 133%
Illinois – 142%
Maryland – 317%
Michigan – 212%
Missouri – 150%
New Jersey – 142%
North Carolina – 133%
Ohio – 206%
Pennsylvania – 133%
Tennessee – 133%
Texas – 133%
Virginia – 143%
Wisconsin – 151%
Disability and financial resources are not factored into the calculation. 39 states have either expanded benefits already, or are in the process of making the change. More states are expected to consider revisions in their eligibility guidelines in future years. States that have not yet expanded Medicaid are Wyoming, South Dakota, Wisconsin, Kansas, Texas, Tennessee, Alabama, Georgia, Florida, Mississippi, South Carolina, and North Carolina.
The important factor is the minimum federal eligibility level (100%) of the FPL. That is, if you are at or below the level, you may be eligible for Medicaid. For a single person, if you make less than $12,880, you qualify. For a family of two, the amount is $17,420. For a family of three, the amount is $21,960. For a family of five, the amount is $31,040 and for a family of six, the eligibility amount is $35,580.
Six years ago, the “expansion” began. Thus (at 138%), a single person could be eligible at about $17,774 while a family of three could earn up to $30,305 and a family of five could earn up to $42,835. In some states, you did not have to wait until six years ago because of recent expansion. Typically, expansion states have lower numbers of uncovered persons, especially in lower-income households. Also, affordability of treatment and access to quality care has increased.
CHIP (Children’s Health Insurance Program) is also offered to children in families that can not afford to buy private medical coverage but also earn too much money to qualify for Medicaid. Each state gets matching dollars from the federal government to provide benefits. Benefits vary by state, but this program is a great cheap option for your children if you qualify.
State And Federal Health Insurance Exchanges And Marketplaces
Six years ago, several states began to operate (most with the help of the federal government) their own Exchange (Marketplace) that offered healthcare to its residents. The majority of states (about 37) allowed the Federal Government to take over the operation, at their expense, of course.
However, consumers would continue to be able to purchase coverage through brokers, and of course our website, to ensure they were receiving the best pricing. The .gov website also became available for persons that lived in states that did not set up their own Exchange. Broker software allows applicants to quickly and easily compare plans and enroll online. Household income, address, and covered member changes can also be easily made without having to visit a government website.
NOTE: Generally, applicants overwhelmingly prefer consumer websites (like ours) instead of applying through the .gov website. Ease of enrollment, time saved (it only takes about 10 minutes) and free unbiased expert advice regarding subsidy calculations, makes a big difference. Also, most persons applying for a policy prefer corresponding (email, phone etc…) with the same person, instead of “starting all over” with each phone call. As you transition into Senior Medicare coverage, our staff can continue to help.
If you need healthcare coverage now, Open Enrollments are available beginning in November of each year and continuing through December 15th. During this period, you can apply for medical coverage and can not be denied because of any current or past medical condition. The exact Open Enrollment dates can change each year. For example, four years ago, the OE period was from November 15th to February 15th. Three years ago, the OE period began November 1st and ended January 31st.
Cheaper catastrophic major medical plans are offered along with lower-deductible comprehensive benefit options. Many plans can be quickly customized to provide lower out-of-pocket costs for specialist visits, non-generic prescriptions, ER and Urgent Care visits, or other anticipated claims. Family members can typically remain on the policy until their 26th birthday.
Senior Medicare Open Enrollment Supplement, Advantage, and Part D coverage) begins October 15th and ends December 7th. When you are first eligible for Medicare, a 7-month Open Enrollment period is provided. It begins three months before the month you reach age 65. It also covers the entire month you reach age 65 and ends three months after the month you reach age 65. Senior contracts are issued individually, so a married couple would own two household plans.
Pre-Existing Conditions Covered
For example, if you were treated for cancer earlier in the year, or you are an insulin-dependent diabetic with many other existing conditions, you will qualify for a policy. And you will be able to choose from multiple top-rated companies. Each state has different participating carriers including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Humana, Kaiser, Molina, Ambetter, and several additional companies.
Additionally, you may be eligible for a federal tax subsidy that could pay a substantial portion of your premium on an individual or family plan. The Federal Poverty Level guidelines are used to determine your eligibility and amount of premium reduction you will receive. For all states except Alaska and Hawaii, the poverty levels are $12,490 (1 person), $16,910 (2 persons), $21,330 (3 persons), $25,750 (4 persons), and $30,170 (5 persons).
Of course, COBRA will only help if you are eligible for benefits. There is no medical underwriting, so your acceptance is guaranteed. If you have lost your coverage, and are eligible for COBRA, you can obtain a policy quickly and avoid any lapse. Usually, companies with 20 employees (or more) will offer this option.
However, the rate is very high. Except for rare exceptions, it could be very cost-prohibitive. But if you need immediate treatment for a sickness, illness or injury, you can utilize this contract and keep it until you qualify for a cheaper health insurance plan. For example, if your surgery and total hospital bill is going to cost $50,000, it is certainly worthwhile to pay two months of COBRA, even if the premium is $1,500 per month.
You can apply for a new plan while your COBRA benefits are in effect. But you should not terminate coverage without consulting with us or an experienced broker that will understand your options.
If you’re age 65 or older, a US citizen, and have lived here for at least five years, you may be eligible for Medicare benefits (assuming you also meet the employment criteria). There is no cost to receive basic benefits and enrolling is a fairly simple process. Although the benefits are fairly comprehensive, there are some gaps in coverage.
A Medigap plan (Medicare Supplement) can be considered, especially during an Open Enrollment period. Your acceptance would be guaranteed and there are more than a dozen different policies available. Since there are variations in benefits, premiums will be different for each option. Covering the Part A and Part B deductibles would insulate you against potential large bills n the future in the event of a sickness or injury.
A Medicare Advantage plan will cost the least. However, their continued availability is questionable. Often premiums are less than $30 per month since the insurers provide basic Medicare and supplement benefits in one contract. These specific types of policies are not available in all areas and are not offered by all companies.
You need health insurance coverage now. It is possible to secure a policy from may reputable sources. Often, the rate will be quite affordable, and benefits are available for all family members.