If you’ve had certain changes in your life like turning 26, moving, getting married, having a baby or losing health coverage, you may still be eligible for a new health plan. You may have less than 60 days after your qualifying life event to make a change. Contact us now about your deadline.
Turning 26 years old
Having a baby
Getting married or divorced
Moving to a new state
Changes to your job status or income
There are four different levels of exchanges health plans: Bronze, Silver and Gold plans are available in all our markets. Platinum plans have limited availability. All of our Health Insurance plans help keep you healthy with $0 preventive care services.
Finding a new health plan doesn’t need to be hard. Our checklists can help you choose what’s right for you. If you’ve already chosen health insurance in 2014, you can keep your coverage or change your plan for 2015. If you’re shopping for insurance for the first time, get started here.
You may want to see if you qualify for financial help (a subsidy), which can lower your monthly health insurance premium. If you qualify for a subsidy, you can subtract some of that tax credit from the amount you pay each month. Visit the links below to see if you qualify.
Think about your 2015 health costs and how much care you may need in 2015. Is it more important for you to have a lower monthly premium and pay more “out-of-pocket” in copays and coinsurance when you get care? Or is it more important for you to pay a little more each month because you may need more care or want to have access to a bigger network of doctors?
The Affordable Care Act is the federal law that requires almost every U.S. citizen to have health insurance or else pay a tax penalty. This tax penalty is administered by the Internal Revenue Service (IRS) through the tax return system and could be subtracted from your potential refund.
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The bronze plan offers the lowest monthly premium, but will result in you paying higher out-of-pocket costs, which means you’ll still pay a higher copay each time you visit the doctor for non-preventive care. You receive your preventive care at no cost. You would choose a plan like this if you don’t plan on needing much health care.
The silver plan offers mid-range monthly premiums, and will result in you paying mid-range out-of-pocket costs, which means you’ll still pay a copay each time you visit the doctor for non-preventive care. You receive your preventive care at no cost. You would choose a plan like this if you want health coverage for basic care needs or if you plan to see a doctor more frequently than your annual preventive appointment.
The gold plan offers a higher monthly premium, but will result in you paying lower out-of-pocket costs, which means you’ll pay a lower copay when you visit the doctor for non-preventive care. You receive your preventive care at no cost. You would choose a plan like this if you need more health care or see your doctor regularly.
We only offer platinum plans in California and New York. The platinum plan has the highest monthly premiums, but will result in you paying the lowest out-of-pocket costs, which means you’ll pay the lowest copay when you visit the doctor for non-preventive care. You still receive your preventive care at no cost.
This is the federal law that requires almost every U.S. citizen to have health insurance or else pay a penalty. The law also creates the structure for a set of government-regulated and standardized health care plans in the United States to be made available on exchanges from which individuals can purchase health insurance for themselves.
If you have a coinsurance, you’ll owe a percentage towards a covered health care service after you’ve met your deductible. Your health care provider picks up the rest of the bill. So if your coinsurance is 20%, your insurance company pays 80% of the cost of in-network care and you pay the remainder.
A copayment is a fixed fee that you pay out-of-pocket for each visit to a health care provider. For example, if your co-payment is $30, then you pay $30 when you see your doctor — usually at the time you receive treatment. The amount of your co-payment sometimes varies by the type of health care service you receive.
Sometimes, you’ll need to pay a certain amount towards your health care first, before for your provider will begin to pay. The amount you pay is called a deductible. So if yours is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible.
The Exchanges are state or federal run online marketplaces offering people a place to enroll for health insurance coverage. The exchanges may offer up to four different standardized levels of coverage to help people compare which option might be best.
These services cover children and adults so everyone can benefit. They include yearly checkups, immunizations, flu shots, cholesterol tests, mammograms and more.
If you think you won’t go to the doctor often, consider a plan with a lower monthly premium and higher copay (out-of-pocket costs) when you get health care. If you think you or your family will go to the doctor more often, consider a plan with a higher monthly premium and lower copay (out-of-pocket costs) when you get health care.
Let’s say you choose a gold plan as an example. After receiving your zero cost preventive care, the plan would pay an average of 80% of covered health care costs while you would pay 20% through some combination of deductibles, co-payments or coinsurance. Similarly, a silver plan pay would pay an average of 70% of covered health care costs while you would pay 30% through some combination of deductibles, co-payments or coinsurance. Bronze plans only cover an average of 60% of covered health care costs, increasing your co-payment to 40%.
The diagnosis, treatment, and prevention of disease, illness, or injury. Health care is delivered by practitioners in medicine, optometry, dentistry, nursing, pharmacy, and other care providers.
Health insurance is a contract between you and the insurance company that says that the insurance company will pay a portion of your medical expenses if you get sick or hurt and have to visit a doctor’s office or hospital. The amount of your bill that the insurance company will pay, and under what circumstances they'll pay it, is known as coverage and can vary greatly from policy to policy.
An out-of-pocket cost would be the amount of money you yourself pay towards your health insurance bills. This may be because of your health insurance plan’s policy, or because you are being billed for a procedure or physician outside of your plan.
Your out-of-pocket limit is the most you will pay for in-network deductibles, co-insurance and co-payments during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit does not includes your premium, balance-billed charges, out-of-network charges or health care your insurance or plan doesn’t cover.
If an individual does not buy health insurance coverage and does not qualify for exemptions, the new Affordable Care Act creates a structure for charging a penalty tax. This penalty tax is administered by the Internal Revenue Service (IRS) through the tax return system.
Pre-existing conditions are health problems you had before getting coverage. This could be something like diabetes, cancer or asthma and you can’t be denied coverage, or charged different rates, regardless of your medical history, gender or health status.
A premium is the amount that must be paid for your health insurance or plan. You usually pay it monthly, quarterly or yearly.
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient. To put it simply, a Primary Care Physician is the doctor you see on a fairly regular basis.
From Feb. 15, 2015, to Oct. 15, 2015, you can only get health insurance coverage through the online marketplace within 60 days of having a qualifying life event.
Examples of qualifying life events include turning 26, moving to a new state, getting married or divorced, having or adopting a baby, or certain changes to your job status or income.
In some cases, misconduct by a non-Marketplace enrollment assister (like a navigator, certified application counselor, or agent or broker) which caused you to not get enrolled or be enrolled in the wrong health plan may also qualify you for a special enrollment period.
After most events, you must lock in your new health benefits within 60 days. If you think you qualify for a special enrollment period, go ahead and start an application. As you finish your application, you’ll see a statement that you can enroll only if you have a special enrollment period. Continue the process to explain your situation and enroll in a plan. You can also contact us now to plan ahead or get help enrolling.
A subsidy is a premium tax credit used to offset or lower the cost of health insurance coverage. U.S. citizens in families with incomes between 100% and 400% of the national poverty level who purchase coverage through a health insurance exchange may be eligible for this tax credit to reduce the costs of coverage, but the amount of the credit received can change based on where you live and what products are available in your marketplace or exchange.
