Q: Can I apply for an Individual/non-employer sponsored health plan at any time?
A: No. If you anticipate enrolling in a private (non employer sponsored plan), you must do so during the open enrollment period (unless you later qualify for a Special Enrollment Period (SEP)):
This year, the open enrollment for 2015 begins on 11/15/14 and ends 2/15/15. Please take note of these additional deadlines:
The deadline to apply for a 1/1/15 effective date is 12/15/14
The deadline to apply for a 2/1/15 effective date is 1/15/14
The deadline to apply for a 3/1/15 effective date is 2/15/14
These deadlines are strict, so I would not wait until the last minute.
Q: What qualifying events would qualify me for a Special Enrollment Period ?
A: Examples include, but are not limited to:
– Gaining a dependent due to marriage, birth, or adoption
– Marriage
– Loss of dependent status (i.e, turning 27 and you can no longer be a dependent on your parents health insurance plan)
– Termination of employment
– Loss of eligibility of a Premium Tax Credit / Subsidy
– Newly eligible for a Premium Tax Credit / Subsidy
– If you move to a new area and your old coverage does not have a good network in that area.
Q:Â Â What is the Health Insurance Marketplace / Exchange:
A: The Health Insurance Marketplace / Exchange is a way to determine whether you are eligible for a Premium Tax credit or Subsidy, provided by the government, to help lower the cost of your Health Insurance Premium. The exchange also allows you to see many different plan options and carriers, and compare their differences. However, in order to get a quote, you need to first apply to determine your eligibility for any cost sharing reductions from the government.
Q: Is there a way to determine my eligibility without going thru the whole application process?
A: Yes. There are income requirements. If you fall into any of the categories below, then it may be beneficial to apply for help. If you do not, then you can apply privately thru any Individual carrier/agent/broker. This will alleviate a lot of hassle!
*$11,670 to $46,680 for individuals
*$15,730 to $62,920 for a family of 2
*$19,790 to $79,160 for a family of 3
*$23,850 to $95,400 for a family of 4
*$27,910 to $111,640 for a family of 5
*$31,970 to $127,880 for a family of 6
*$36,030 to $144,120 for a family of 7
*$40,090 to $160,360 for a family of 8
It is important to note that if you fall below the lower income limitation for your family size, you will automatically be qualified for Medicaid and you will not be eligible for help paying for a Private Health Insurance Plan.
Q: Can I use a broker if I want to purchase a plan on the exchange?
A: Yes. Although a broker cannot apply ( the application includes a lot of private information that only you would have access to) for you, they can help you navigate the different plan options, and even quote the plans that are available on and off the exchange.
Q: Are there any waiting period for pre-existing conditions?
A: No, there are no longer waiting periods for pre-existing conditions, and all health insurance plans are now guaranteed acceptance.
– written by Rebecca Starck
Rebecca Starck has been working in the Insurance Industry for 12 years. R.A. Starck Insurance was founded in 2004 with the goal of empowering their clients with the information necessary to make informed decisions. R.A. Starck Insurance provides educational materials, quotes, and customer/policy support.
Please do not hesitate to contact them with any questions!
Rebecca Starck
R.A. Starck Insurance
Tel: (773) 856-6030
Mobile: (773) 817-0669
Fax: (415) 946-3449