The Affordable Care Act which was enacted in 2010 came in full effect in the individual market on January 1, 2014 after the first Open Enrollment that started in the fall of 2013.
Despite the fact that we have had 8 Open Enrollment Periods many people are still confused about what their options are. See below for 8 common questions people still ask?
Frequently Asked Questions
Who should go to the health insurance marketplace to buy health insurance?
It is recommended that everyone shopping for health insurance in the individual market start with the Health Insurance Marketplace or healthcare.gov. By checking the Health Insurance Marketplace first, you will be able to see all the health insurance plans that are available in your area. These are the ONLY plans that are available in your area in the individual market that comply with the Affordable Care Act (ACA). If you want to receive financial assistance, subsidies are available only by going through the Health Insurance Marketplace.
Who should buy health insurance through the health insurance marketplace?
The Health Insurance Marketplace was created to make it easy for people to shop of health and dental insurance in one place and to make financial assistance available to them if they qualify. If you want financial assistance you MUST apply for health insurance through the Health Insurance Marketplace. If you do not qualify for a subsidy you do not need to use the Health Insurance Marketplace to purchase your health insurance although you do have the option to do so. If you do not qualify for a subsidy at this time and you know for sure that your income will go down in the near future qualifying you for a subsidy, only in this case would it make sense for you to apply using the Health Insurance Marketplace. By applying through the Health Insurance Marketplace, you will be able to update your income information anytime it changes. If your new income level qualifies you for a subsidy it will be applied at the time you make the change. You may need to provide proof of income.
If you do not qualify for a subsidy it is still recommended that you “check” the Health Insurance Marketplace to see what health insurance companies are available in your area. This is the only way you can be sure that you are being shown all available plans if you choose to use an insurance agent or broker. If your income is expected to stay the same, it is better to apply directly with the company either yourself or through an ACA certified agent or broker. You can find an ACA certified agent or broker in your area by going to healthcare.gov.
If I cannot afford to buy health insurance will I have to pay a fine?
At the Federal Level effective January 1,2019, the federal mandate penalty was reduced to $0. The penalty still exists but since it has been reduced to $0 you currently do not have to pay. The mandate penalty can be raised again at any time. There are some states that have a mandate penalty at the state level. These states are California, The District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont
Are there any options if I cannot afford a major medical health insurance plan?
There are NOT any ACA compliant health insurance plans available in the individual market unless you qualify for a Special Enrollment Period outside of the annual Open Enrollment Period which varies by state. Some states have ACA mandate exemptions for people who have enrolled in a Health Sharing Plan that meets certain guidelines. Not all Health Sharing Plans are ACA exempt and depending on where you live you may be subject to any existing penalties. Health Sharing Plans ARE NOT INSURANCE. They should not be considered a health insurance alternative but should be viewed as an available option that may or may not help cover your medical expenses. Health Sharing Plans do not guarantee that your medical bills will be paid.
Some states have expanded and enhanced the benefits of Short Term Medical Plans allowing them to be renewed for up to 3 years. Short Term Medical Plans are not required to cover all the benefits that are mandated in ACA compliant plans. If you choose to purchase one to cover some of your medical cost be sure that you are made aware of any exclusions which vary by plan. Short Term Plans are not designed to be used long term.
Other Limited Benefit Supplemental Plans are available but should not be viewed as an alternative to a major medical health insurance plan.
Is healthcare.gov the only place where I can shop of health insurance?
No. While healthcare.gov is the place where you should go to be sure that you are presented with plans from all of the companies available in your area in the individual marketplace, there are other available sign up platforms that have been approved by CMS. These sites are approved web broker sites and are used by many insurance agents and brokers and some insurance carriers. You can see a list of approved web brokers here.
What is the advantage of using a broker that uses an approved web broker site?
An insurance agent or broker who chooses to use an approved web broker that has access to the Enhanced Direct Enrollment Platform or (EDE) as of 2020 can do all the following:
See all the people who they assisted with a health insurance enrollment including all their dependents.
They have access to Eligibility notices and 1095-A forms which can be sent to you if needed in a shorter amount of time.
They can upload required documents directly to the Health Insurance Marketplace and see in real time when they are approved.
They can assist you with your first payment and verify if it has been received by the company.
You save time by not having to wait on hold with the Health Insurance Marketplace.
You can sign up on your own by requesting a link from an ACA certified agent or broker who uses an approved web broker site. By doing this you can sign up independently and only contact your broker if you need assistance.
All the information you enter in the application on a web broker site with EDE capabilities will be synced with your application on the Health Insurance Marketplace
How can I know if I qualify for financial assistance to purchase health insurance?
The only way to know if you qualify for financial assistance is to fill out an application. You can use the estimator tool on healthcare.gov, Health Sherpa or any approved web broker site in your state. Based on the information you put in the estimator it can give you an idea of what you might qualify for. You may be able to get quotes for subsidies in state-based exchanges on a CMS approved web broker site, but you will not be able to complete your enrollment. You will need to use the Health Insurance Marketplace Exchange site for the state you reside in. You can complete your application on an approved web broker site if your state uses the federal marketplace or healthcare.gov for health insurance enrollments.
Should I purchase dental insurance through the health insurance marketplace?
Whether you choose to purchase a dental insurance plan on or off the Health Insurance Marketplace Exchange is a personal choice. There are many more options for dental insurance off the exchange. When you purchase through the exchange you will be putting a third party between yourself and the insurance company. If you have any issues with your account, you can only make changes by going through the Marketplace. You cannot call the insurance company to make changes if you apply through the Marketplace. There is no financial assistance for dental insurance. The prices are the same both on and off the exchange.
For in person assistance at any time during the application process in MD or VA contact me