Shop and Compare Health Insurance Plans

The first step toward identifying which healthcare insurance plan is right for your situation is to understand your specific healthcare needs and financial situation. These are both important factors that determine what plan is right for you.

If you don’t see the doctor often and maintain relatively good health, opting for a health insurance plan with a higher deductible and lower premiums may help you save money. However, a downside of this type of plan is that you leave yourself susceptible to the risk of large, unexpected medical bills in the case of an accident.

If you prefer paying higher premiums with lower cost-sharing or require more than basic preventative medical care, you could consider plans with lower deductibles and coinsurance predictable costs.  

Most states have Open Enrollment for the Affordable Care Act (ACA) health insurance beginning November 1st through December 15th. There are, however, states that have permanently extended open enrollment. It is a requirement that an individual is a resident of the state in which their health insurance plan is filed.
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Some states with permanently extended open enrollment periods as of 2021 are:

• Colorado: November 1, 2020, through January 15, 2021
• California: November 1, 2020, to January 31, 2021
• District of Columbia: November 1, 2020, to January 31, 2021

A special enrollment period has been in effect since February 15, 2021, and will continue through August 15, 2021, for individuals and families with ACA marketplace coverage as a direct response to the Covid-19 health pandemic. This special enrollment period is only valid for residents of the 36 states that the Health Insurance Marketplace serves.

Typically, the Open Enrollment period at the end of the year is the only time to buy ACA-qualified health insurance via the private market and you cannot buy it after the state-specific cut-off date. However, there are qualifying life events that give you a sixty-day period to also enter into enrollment.

Some individuals may qualify for Special Enrollment if they lose coverage previous held through a parent, spouse, or another family member in these situations:

• You can no longer remain on your parent’s health insurance plan as you’ve turned 26 years old.
• A parent or guardian lost the employment that provided you with health insurance.
• You lose health insurance through a family member’s employer because your family member loses health coverage for their dependents
• Legal separation or divorce from a spouse resulting in loss of health insurance coverage.
• A family member dies that previously provided you with health insurance.
• You recently became a U.S. citizen, making you newly eligible for an ACA marketplace insurance plan.
• You recently gained membership to a federally recognized Native American Indian tribe.
• You recently gained the status of an Alaskan Native Claims Settlement Act (ANCSA) shareholder.
• You began or completed service as an AmeriCorps State and National, VISTA, or NCCC member.
• You are newly released from incarceration.

Sometimes referred to as Obamacare, the Affordable Care Act of 2010 defines a list of ten essential health benefits that individual medical plans offered on the marketplace must cover in order to be a recognized ACA plan.

The list of legally required services present in ACA health insurance plans are outpatient, emergency services, surgery, maternity and newborn infant care, mental health services, prescription drugs, preventative and rehabilitative care, along with lab services and pediatrics. This type of health insurance plan comes with higher premiums than non-ACA short-term health plans but offers much greater coverage levels.

In most cases, a waiting period is required prior to your health insurance coverage beginning.

You won’t begin paying your premiums on new healthcare coverage until that coverage begins on January 1st. If the reason you qualify for an ACA plan is a qualifying life event, your coverage may not begin for at least two weeks.

The specific cost of different plans’ premiums varies between plans. However, subsidies do exist and may be available.

Subsidies may cover part of your premium or out-of-pocket if your income is less than 4x the federal poverty level. ACA plans help manage expenses because of the cap on what you are required to pay. In 2020, the maximum out-of-pocket cost was $8,200. For families, this was $16,000.  

The ACA marketplace offers four levels of health insurance plans, each one paying a different portion of your health care bills.

An estimation of what an insurance company will pay per level of insurance plan follows:

• Bronze 60%
• Silver 70%
• Gold 80%
• Platinum 90%

Individuals enrolled through the Health Insurance Marketplace may be able to lower their per-monthly out-of-pocket costs that can help make insurance plans more affordable for more individuals.

You must meet specific requirements to be qualified for tax credits:

• You are enrolled in coverage through the marketplace, excluding “catastrophic coverage.”
• You are unable to gain insurance through employer-sponsored insurance plans.
• You do not qualify for government-run programs like TRICARE, CHIP, Medicaid, or medicare
• Your income is at least 100%, though not exceeding 400% of the federal poverty line.
• You’re married and file taxes jointly.
• You are not listed as a dependent on anyone else’s tax return.
• You are not listed as a dependent on anyone else’s tax return.

The marketplace will determine your eligibility. You can see if you’re eligible by answering a few simple questions.

You can buy either indemnity or short-term health insurance at any time but cannot change or purchase ACA health insurance outside of the standard Open Enrollment period, unless you have a qualifying life event.

Life qualifying events include:

• Loss of health coverage through the loss of a job due to no fault of your own.
• Having a child or adopting a child.
• Moving from one health insurance provider’s coverage area to another’s territory.
• Getting married
• Turning 26 years old and subsequently losing previously held health insurance that came as a result of losing your parents’ health insurance.
• You are not listed as a dependent on anyone else’s tax return.
• The cancellation of your current healthcare insurance plan.