There is no telling when a visit to the doctor or the hospital might be warranted. It would be great if we all were healthy 100% of the time, but that’s not realistic. Accidents happen. Acute illnesses come and go. Medical conditions are newly diagnosed and treated. All of these services can be extremely expensive to pay out of pocket. Health insurance can help make costs for care more affordable.
If your employer provides health insurance, this is part of your benefit package. However, what if health insurance isn’t provided and you don’t have access by any other means? Here we will review individual health insurance and when you get signed up for a plan.
Health Insurance Background
The Affordable Care Act was passed by Congress and signed by President Obama on March 23, 2010. Since the passage, we have seen some changes in the way people get their health insurance. The health insurance market is divided by individual policies, and group or employer coverage. In the individual market, there are subsidies provided to help with the cost to purchase an insurance policy to make it more “affordable.”
When can I sign up?
There are two major changes in the individual market:
- Health questions can no longer be asked, which make the policies guarantee issue.
- Policies can only be purchased during open enrollment: November 1 to December 15 each year. If you miss “open enrollment,” you will not be able to purchase a policy until the following year.
Short Term Health Insurance
There is one exception to being able to get a health policy outside of open enrollment. It is called a short term health policy. Be careful here though!
- Pre-existing conditions are not covered.
- These are medically underwritten, so you could get denied.
Special Election Period
In the case that you would have a Special Election Period, such as getting married, losing employer coverage or having a child, then you have the ability to purchase a health plan at that time. Talk to your insurance professional promptly about the life change to review your health insurance options.
Qualification for a Subsidy
The State of Ohio did expand Medicaid. For an individual with an annual income of $16,643.00 or below, he or she should be eligible for Medicaid.
Once the annual income goes over that amount, then there would be eligibility for a subsidy to help purchase a plan. The subsidy helps to make the plan more affordable. In some instances, the subsidy may be higher than the premium. Consequently, they would have a zero premium.
These health plans have been a great option for those who are self-employed, those who work but are not offered insurance, or those who have lost prior coverage.
Note: You are not eligible for a subsidy if you are eligible for an affordable workplace health plan!
For a couple in their early 60s with an income of $60,000, the subsidy would be around $1800 per month to purchase a health plan.
Careful consideration needs to be taken when picking out a health plan. Pay particular attention to the networks, because they are different than the more familiar workplace plans. We encourage you to work with an insurance professional to assist in explaining and picking the right health plan for you! We are happy to help. Provide us with initial information by clicking on the image below and we will be in contact soon!