As a spin-off to my life lessons series, I wanted to continue to bring you information that is most pertinent to your life. So today, we’re going to talk about health insurance and the way that the industry works today.
What makes me an expert?
Many may not know that my day job is within the health insurance industry and although i am not a licensed agent, acting as a consultant to agents that sell Blue Cross Blue Shield of Michigan insurance is just one of my many job duties within my company. Although I am mostly knowledgeable in Blue Cross Blue Shield of Michigan’s products, I will provide you with non-biased information that you can apply to most carriers as their guidelines should be primarily based on the rules of The Affordable Care Act. Besides this post, I will be writing three other posts during the open enrollment season to better assist you with this process in hopes that you become more knowledgeable about what you can and can’t do when attempting to purchase health insurance.
Open Enrollment begins Saturday, November 15, 2014 and ends on Sunday, February 15, 2014.
What is Open Enrollment?
It’s an opportunity for anyone (not on a group or employer-sponsored plan) to purchase an Individual or Family health insurance plan so that they’re not penalized and for need of healthcare coverage in general. To make changes or additions to their plans without a qualifying event. No one can buy health insurance once open enrollment closes unless they have a Qualifying Life Event .
Examples of QLE’s
-Loses health coverage involuntarily
-recently released from incaration
-moved from to a new service area (i.e. moved to MI)
-Loss of Medicaid/CHIP
-No longer eligible to be on parents plan/turned 26
-Primary subscriber ages into Medicare
*If you do not have a qualifying event, you will not be eligible for a special enrollment period outside of Open Enrollment. This can be appealed for special cases and is solely at the discretion of the carrier or Healthcare.gov (which ever service you enrolled through)
Applicant’s have two options:
1.) Enrolling on the Marketplace: The marketplace is administered through healthcare.gov and applicants are able to see if they qualify for a Subsidy (a discount on their premium every month or in the form of a tax credit when they file their taxes) or a Cost-Sharing Plan (the carrier picks up a greater portion of the co-insurance essentially reducing out-of-pocket costs).
*Only certain plans may be eligible for cost-sharing, please inquire with the carrier you wish to receive coverage from
*Subsidies can be applied to any plan, if eligible
Keep in mind: If you enroll “On Marketplace”, changes must be made to your plan ON THE MARKETPLACE. Your plan is administered on the Marketplace so changes cannot be made by going directly to the carrier as they do not have access to your info until it is released by the Marketplace and it is solely for billing purposes ONLY.
A lot of people enroll on the marketplace because they want the discounts ( or just prefer to use the website) but do not realize that they’re the sole admin of their application and changes cannot be made except through them. This frustrates many people as they’re not always able to get through to customer service or even back into the website to make changes due to the high volume of calls to their phone lines and traffic to their website. Please keep this in mind when choosing where to purchase your coverage.
Tip: Unless you qualify for a subsidy, cost-sharing or wish to purchase a plan that is ONLY offered on the Marketplace, it isn’t necessary to purchase insurance on the Marketplace as it’ll only add to your frustration when trying to get an issue fixed later on down the road. Most plans are offered on and off Marketplace, so choose wisely!
2.) Off Marketplace: applications are administered directly through the carrier and can be purchased online, by phone, with a licensed agent or applications can also be mailed and faxed in. This is the more favorable alternative for applicants that don’t qualify for subsidies or cost-sharing.
Tip: Obtain a health insurance agent as they’ll be able to better assist you in understanding how health insurance works thus helping you decide which plan is best for you. (I’ll be discussing the importance of obtaining an insurance agent in my next post)
Agents also act as liaisons between the member and the carrier and can often assist you, if you experience issues with you’re plan or coverage. It is free to obtain a health insurance agent but remember that agents work off of commission and don’t profit until you pay your monthly premium so don’t obtain an agent if you’re not sure about purchasing insurance. No one likes wasted time!
Deadlines: Please keep in mind that carriers work off of deadlines and your effective date of coverage is dependent on when you get your application in.
I.E: November 15-December 15, applicants need to submit applications for a 01/01/2015 effective date, if an application is received on 12/16/2014 the member will be assigned a 02/01/2014 effective date.
Healthcare.gov is an excellent resource to better educate yourself on The Affordable Care Act and the Individual Mandate( The fee you pay if you don’t have insurance) as well as the carrier of your choice website or customer service line.
Feel free to pick my brain as I’m very familiar with the way this works due to the fact that I’ve been working in this industry for about a year and a half and have seen the many changes that have happened since then.
Stay Ambitious! Stay Motivated!