No medical insurance and you missed Open Enrollment. Now what should you do. The answer is easy. Or is it? You simply view free healthcare quotes online and buy a Marketplace policy from a reputable website or broker. There are no physicals to take and once approved, you can utilize benefits. That wasn’t so difficult! Medically-underwritten plans (including short-term coverage) are offered outside the OE period, which typically ends January 15th.
We explain the process, review what plan options are available for yourself and your family, and help you obtain a policy that fits within your budget, and helps cover most of the medical expenses you are likely to incur. Although qualified Marketplace plans are not offered without an approved SEP exception, other options are available. However, maximum annual and lifetime coverage limits may be applied to policies, and popular benefits, including maternity and mental health, may not be included.
How is your health? Do you have serious medical problems that need immediate attention? Or have you received treatment for internal cancer or heart disease within the last seven years? If you have serious medical conditions, obtaining coverage through Open Enrollment might be the best choice. Prior to the Affordable Care Act, a State Risk Pool was established to find affordable medical family coverage for persons that otherwise could not find a company that would insure them. Pool rates were expensive and out-of-pocket expenses were high.
But the “Pools” no longer exist and many other changes have occurred. The type of policy that is offered in your area is different and many benefits must now be included to comply with federal guidelines. In many states, Medicaid has been expanded to help lower-income residents find and qualify for affordable benefits. CHIP for children is very popular and is often available in moderate and above-average income households. As federal subsidies increase (2023 subsidies increased), more low-cost options become available through Exchanges.
Open Enrollment And Exchanges
When you apply for coverage during Open Enrollment, you do not have to answer medical questions. Any conditions you are being treated for (past or present) are covered, and you can secure benefits quite quickly. The policies are purchased through a “Marketplace” (Same as an “Exchange”), and many of the biggest companies participate in your state. Large carriers, including Aetna and UnitedHealthcare, have recently increased their states of participation.
Here are how the Exchanges work. After you get a free quote from our website, you can choose to apply through an “Open Enrollment” period. Each state has one and we’ll walk you through the process. Do you have any serious medical issues? It will no longer matter since an Open Enrollment accepts all applicants regarding of what pre-existing conditions you have (or had). However, applicants that are eligible for Medicare or Medicaid are typically not eligible for instant tax credits.
Federal Subsidies To Help Pay Your Premium
Also, depending on your projected adjusted gross income on next year’s tax return, you could receive a substantial discount on your healthcare costs. If that income is between 100% and 400% of the Federal Poverty Level, you will receive aid. Additional information is found on the official government website which can be accessed through this link.
The assistance is in the form of “subsidies,” which are one of the main components of Obamacare. For example, a family of four (parents ages 50 and 48) with a household income of $55,000 living in Charlotte, NC (Mecklenburg County) can receive about $13,000 per year to help pay for their policy. A single parent (age 30 with one child) that makes $36,000 per year can receive about $4,000 per year. Amounts and eligibility will vary, depending on your county of residence.
Naturally, the lower your income, the larger the deduction you will receive to pay the premium. And whether you have existing coverage or not, it will not matter at the time you apply, assuming you don’t miss the designated deadlines. For Marketplace plans, there is no discount or surcharge for having prior coverage.
Not Covered? You May Have To Pay A Special Tax
It is important, however, to understand that a special federal tax will be imposed if you don’t purchase a policy that meets mandated guidelines. This penalty is pro-rated, so if you obtain qualified coverage throughout the year, the full tax will not apply. For 2016, the penalty was 2.5% of the entire household income.
Beginning six years ago, it became “the law” that you must purchase and maintain qualified medical insurance. Otherwise, the previously-mentioned tax will be assessed that will increase each year. This “mandate” has been a controversial topic but has survived initiatives to remove it. Major insurance companies strongly support the tax, since as many healthy applicants as possible are needed to keep the ACA legislation afloat.
If you don’t have any serious medical issues, unless you are receiving a large subsidy, selecting a Platinum or Gold-tier plan may not be the best option. Why? Because you will be paying thousands of extra dollars for the convenience of a lower deductible and out-of-pocket expenses. If you don’t meet that deductible, selecting a Bronze or Silver-tier policy would have significantly reduced your premium.
An agent or broker with at least 20 years of experience, that represents multiple companies is a good resource. Or, you can simplify the process and save time, and get your health insurance quote at the top of the page (by providing your zip code). You always receive the lowest available rates offered by all of the companies.
What Type Of Policy
What type of coverage do you want? If you are mainly concerned with “big ticket” items such as hospital and surgery expenses, then a “high deductible” policy will suit your needs best. The rates are low and policies like this (catastrophic plans) will pay for the big expenses and allow you to sleep at night!
Although it’s tempting to go without coverage, the risk is simply too great. And with no lifetime maximum on the amount of benefits paid, regardless of the severity of your condition, expenses will be paid. Selecting a Bronze, Silver, Gold or Platinum “Metal” plan from the Marketplace (as previously discussed) requires expert and unbiased assistance, which we provide. Depending on whether you have any chronic conditions, you may not need to select the most comprehensive option. Bronze and catastrophic contracts are the most economical, but also require you to share more of the expenses.
If you are willing to pay a higher rate in exchange for much better office visit and prescription expenses, then a “comprehensive” policy might suit your needs the best, depending on your deductible. This type of policy (Platinum Plan) is much more common when you have multiple dependents and the likelihood of many more claims is likely. During Open Enrollment periods, you can always change from one type of policy to another, or from one carrier to another.
How Much Do You Have To Pay Now
That varies. Most companies allow you to apply for a policy without paying an upfront premium and without providing any credit card or billing details. Short-term, supplementary, and ancillary (dental and vision) generally require a payment of the first monthly premium at the time you apply. However, many carriers do require you to give them billing information.
Often, once the policy is approved, you will be charged that premium. Of course, you can request a refund if the policy is unacceptable to you. And all companies allow you to pay for your coverage monthly and sometimes quarterly.
How Long Will It Take To Get Your Policy Approved?
Not too long. If it is a short-term policy, then you can expect an answer from the underwriter within a few days. Sometimes you are immediately approved. If you have not had a physical in the last 5-10 years, and you are 50 or older, additional requirements may be required on temporary policies, especially if you have no prior healthcare coverage. Although most major carriers do not have temporary plans in their portfolio, UnitedHealthcare and many Blue Cross companies do offer these options.
If there are existing conditions, on all Marketplace and Exchange plans, it will not impact the underwriting process or the cost of coverage. However, because Open Enrollment applications are submitted fast and furiously, there can be delays in processing billing, policy approvals, and creation of ID cards, especially from November to February.
If you request a specific date for the policy to take effect, generally that request is honored if the process takes longer than anticipated. Of course, this assumes you are approved and you accept the offer that is made by the insurer. It’s also important to cancel prior coverage if you enrolled for new coverage to replace an existing policy.
The Insurer Told Me My Policy Was Approved. Now What?
Congratulations! You now have medical insurance! Your ID card will be arriving shortly with a policy that may take you a few weeks to read! But take the time to read it and make notes of any portions of the contract that you don’t understand. Before you seek treatment, make sure your providers are “in network.” The provider list can be found online or provided by your broker who sold you the medical plan. And each year, new providers may be added.
If the policy was a “Marketplace” contract, although it can be canceled at any time, you may not be able to change to a different plan until the next Open Enrollment. However, there are many exceptions, including moving to a different area, reaching age 26, losing employer-based benefits, and certain changes in income.
How Long Do I Have To Keep The Plan?
You can cancel your policy at any time. However, before terminating coverage, other qualified benefits should be arranged so you avoid the Obamacare non-compliance tax for being uninsured. There is a 90-day grace period before you are assessed the extra tax. If you are terminating a short-term or non-Obamacare policy, although there is not an ACA tax assessed because you canceled the plan, you will be subject to the penalty if you don’t obtain qualified coverage.