For every person, there comes a time when they must consider buying a health plan. Many people get coverage as a dependent. The Obamacare rules permit children to stay on a parent’s policy until age 26. Buying a health plan is usually simple and straightforward of it coincides with the open enrollment for the next calendar year.
Loss of coverage can qualify as a status change that requires a special enrollment period. If after open enrollment, and if nor qualifying for a special enrollment, there may be few options. When selecting health insurance from the Obamacare Marketplace, a private insurer or elsewhere, comparison shopping is essential to getting the best coverage for the right price.
Comparison shopping can help the consumer find the plans that are most responsive to the individual or family situation. Enter your zip code to compare free quotes right here!
The Individual Mandate
The Affordable Care Act requires that every eligible person gets and keep qualified health insurance coverage. Those that fail or refuse to do so can face a penalty for each uninsured month of the calendar year.
Compliance with the law is the driving force for one’s first health policy. While compliance may be the reason many people buy their first health insurance policy, health insurance coverage is a vital item for personal and family security.
A major illness can create a mountain of medical debt. In some areas, an appendectomy and short hospital stay can cost well over $100,000.
The open enrollment period is an annual event that permits every eligible person an opportunity to examine and compare insurance plans and to select qualified health insurance.
The 2017 calendar year open enrollment period ran from November 1, 2016, through January 31, 2017. During this time, everyone eligible to participate could buy insurance. After open enrollment, the rule is that no one can buy insurance until the next open enrollment period.
Special Enrollment Periods
Special enrollments are in the Affordable Care Act because life is fluid and ever-changing. Some changes affect one’s status, and these changes require a new opportunity to buy health insurance. The states and the marketplace have recognized the below-listed occurrences as qualifying life events.
Life events yield a 60-day period for reviewing and selecting policies. Special enrollment periods include the financial and technical assistance from the marketplace and state exchanges.
How to Buy a Health Insurance Policy
From the inception in 2010, the Affordable Care Act implementation has included a significant amount of information and assistance for consumers. The law is complex as is the health insurance industry. The changes that the Congress intended were to consumers get coverage and regular medical care.
From 2013 to the present, the administration of the Affordable Care Act included person assistance and experts to help and guide the consumer through the selection process. The below-listed items describe the many ways that one can apply for qualified health insurance.
- Online at the federal Marketplace
- Online through your state exchange’s website
- By telephone with the federal Marketplace
- By email with state or federal web portals
- By mail or fax with state exchange or federal Marketplace
- By paper or hard copy mail
The most important change in policy in the Affordable Care Act is in universal acceptance; the insurers can no longer deny coverage because of prior health or other conditions. Similarly, they may not charge more for pre-existing conditions. In the rating system allowed by the Act, community rules apply with the exception and narrow use of the below-listed factors.
- Tobacco usage
The Federal Marketplace
The Centers for Medicare and Medicaid operate the federal marketplace. They review the contents of plans before they can go on sale at the Marketplace or state exchanges.
While CMS does not get involved in plan details, they may do so in the future to help drive down the price and increase value. Many states play that role. Called the active purchaser, the states have shown a capacity for using oversight to get better plans.
Buy from Brokers and Agents
Buyers with incomes at or above 400 percent of the federal poverty level can get little or no assistance from the Marketplace or state exchanges. These buyers should shop outside of the marketplace to find offers that satisfy the mandate and which respond to their needs or preferences.
Brokers represent no particular carrier but usually have a wide range of experience placing clients with the best plan. Brokers understand health insurance and the trends within the industry. They are well positioned to find qualified health insurance and, if qualified, the best package of credits and assistance.
Similarly, agents have in-depth knowledge of the health insurance markets. They differ from brokers in that they usually carry products from a single insurer. This can be an advantage since the agent can promote all of the qualified insurance plans from that source.
When getting health insurance it is important to consider the tax consequences. For example, self-employed persons enjoy a great tax break. They can deduct all of the expenses and premiums for themselves and their dependents. premium tax credits can lower the out of pocket expense of premiums. The adjustment for unused credits comes at year-end through the tax filing.
Getting coverage is the goal, and sign-ups are simple during the open enrollment season. The assistance personnel and navigators can guide the consumer through the process from the first search to sign-up.
The same ease of enrollment follows the special enrollment periods. The Marketplace and state exchanges will provide assistance as requested. The federal marketplace and state exchanges can authorize premium tax credits and cost-sharing reduction assistance.
The law requires insurance coverage, and it must be qualified coverage that meets the standards of the Affordable Care Act. Comparison shopping is the proven method for finding high-value policies that meet the consumer’s needs.
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