With the new year and new decade upon us, you may be expecting some life changes. Or you may not be expecting them at all, they just happen. In the either case, it’s important to be prepared and knowledgeable about your options when it comes to your health insurance needs.
If you do experience one of the life changes mentioned below, you may qualify for what is known as a special enrollment period (SEP) which allows you to purchase major medical insurance outside of open enrollment.
Because certain events, like adding a member to your family, moving out of your health plan’s service area or losing coverage through your employer means you may need to modify or choose new coverage, the ACA, sometimes called Obamacare, makes special allowances for this. These specific, qualifying life changes may open a small window of time that will allow you to purchase new ACA health insurance coverage.
These types of life changes are called qualifying life events (QLEs). Some common qualifying life events are:
• Marriage or divorce
• Adding a family member through birth or adoption
• Turning 26 and losing access to parental health coverage
• Loss of eligibility for Medicaid
• A loss or change in employment
• Moving out of current plan’s service area
• Return from active duty in the Armed Forces
It’s important to remember that these events create an SEP for a limited time only, you usually have up to 60 days following the event to enroll in a plan ACA Marketplace plan. Anyone applying once his/her SEP has expired will not be able to make health insurance elections. The federal government and many insurance companies also require specific proof of these events.
If your employer-sponsored health coverage ends…
Most of us have experienced some kind of change in our employment. These kinds of big changes are sometimes expected, sometimes they’re not. It’s important to understand that a job change may mean you’re eligible to make changes to your health coverage, even outside of open enrollment.
One of the toughest things about a job change can be the loss of employer-sponsored health coverage. If you’re experiencing a change in employment, be prepared to work closely with the HR department and/or a benefits administration company. You’ll want to ensure you’re being offered coverage for the time period for which you’ve already paid from your paycheck; this may be beyond your termination date.
Health coverage decisions after a job change.
You may also be offered coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA) which mandates that some employees be allowed to maintain coverage through the employer’s group plan—albeit on your own dime. COBRA can be expensive and only lasts for a defined period of time, typically 18 months.
Another, usually more affordable option is buying a new plan through the Affordable Care Act1 Marketplace. When this health insurance law took effect, it introduced open enrollment periods for individuals and families who were buying insurance for themselves. Outside of open enrollment, which ended on December 15, 2018, the average consumer can’t purchase insurance.
However, when you experience major life events (like a job change), you’re allowed to buy insurance outside of open enrollment during what’s called a special enrollment period. Although paying for your own insurance may still be more expensive than what’s offered through an employer, some health plans bought through the ACA Marketplace are eligible for premium tax credits (help paying for your coverage each month) and cost-sharing reductions (help lowering out-of-pocket costs like deductibles).
Does alternative coverage fit your needs?
ACA alternatives can be enrolled in at any time throughout the year and can typically be more affordable than traditional ACA plans, but with more restricted and limited coverage. If you are in good health and only looking for coverage on unexpected medical care, short-term medical (STM)2 insurance may be a good option for you to explore.
Short term insurance can help offset medical bills from injuries or illnesses. Short-term insurance provides limited benefits designed to cover individuals for a pre-determined length of time.
Short-term medical insurance can help offset medical bills from injuries or illnesses and designed to cover individuals for a pre-determined length of time. These periods can range from a few months up to a year, depending on your state. These plans are flexible and customizable – you can choose from various premium, deductible and health benefit levels. STM plans can also be used alongside other supplemental insurance option such as accident or critical illness insurance for even more coverage.
To determine if your life event qualifies you for a special enrollment period and to get insight on the health coverage options available to you, consult with a licensed agent. Even if you aren’t eligible to purchase outside of open enrollment, an agent can advise you on your alternatives. Call today for a free insurance consultation with a licensed broker call 985-778-0072 or visit K.F. Gourgues Marketplace for more information.
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Please visit www.LouisianasMarketplace.com for some great options in potentially reducing your Health coverage cost. Or better yet, call Kevin directly at 985-778-0072 to explore alternative solutions that just might save a bunch of moula!
•More Options •Better Alternatives •True Health Coverage for Less
1ACA = Short for the “Affordable Care Act.” ACA health insurance plans that meet the minimum essential coverage requirements and cover pre-existing conditions as well as the 10 essential health benefits (e.g. maternity care, mental health, preventative care, prescription drugs, and more). ACA plans also offer subsidies and premium tax credits to eligible individuals based on income. These subsidies and credits are designed to lower your ACA plan’s monthly premium. Individuals may only enroll in ACA coverage during the annual Open Enrollment Period (November 1st – December 15th) unless they have a Qualifying Life Event. Visit Healthcare.gov for more information.
2Short Term Medical (STM) and other ACA-alternative plans are medically underwritten and are not required to meet the minimum essential coverage requirements or provide the 10 essential health benefits as mandated by the ACA. This means that non-ACA plans may not cover certain types of services, including but not limited to: maternity care, mental health, preventative care, and prescription drugs. Non-ACA plans are also not required to cover pre-existing conditions. STM plans vary per state