Obamacare offers individuals several health insurance coverage options. People can purchase marketplace plans or enroll in Medicaid depending on their needs and income levels.
Individuals typically enroll in Affordable Care Act health plans during the annual open enrollment period; however, certain life events may allow some to submit applications outside this window.
Open Enrollment Period
The Affordable Care Act’s open enrollment period occurs each fall and winter from November 1 through January 15 and allows anyone who meets eligibility requirements to purchase plans on the marketplace.
Certain major life events may trigger special enrollment periods outside the annual open enrollment period, including moving, marriage, having a baby or losing current coverage. Once qualifying for such an enrollment period, you have 60 days in which to purchase health insurance policies.
Most states also provide Medicaid and CHIP plans to low-income families in addition to marketplace plans, covering most of your health care costs. You can enroll anytime throughout the year. If you miss the 2023 open enrollment period, short-term insurance or supplemental policies may provide coverage – compare costs and benefits before selecting one as some plans cost significantly more than others.
Special Enrollment Period
Through out the year, there are opportunities for enrolling in a qualified health plan (QHP) outside of its annual open enrollment period. These special enrollment periods enable people to purchase private coverage triggered by major life changes such as marrying someone new or losing current coverage.
Under ACA regulations, a special enrollment period of 60 days from the date of a qualifying event allows individuals to select or modify existing plans or enroll for new coverage – even if other qualifying plans such as employer plans or COBRA coverage exist.
New rules released in 2018 clarify that becoming dependent triggers an effective date, meaning coverage purchased can start on the same day as other qualifying coverage if applicable – applicable both to adults and children alike; this provision may or may not be available through all exchanges and markets.
Coverage Options
There are various Affordable Care Act-compliant health insurance plans available. Some, like eHealth Marketplace’s Preferred Provider Organization (PPO) plan, are cost-effective and flexible plans with numerous benefits for you to take advantage of. Others, less flexible but more costly plans come with higher deductibles that must be paid before they start paying anything towards care from their insurer.
The Affordable Care Act categorizes health insurance plans compliant with its standards into four metal tiers based on monthly premium and deductible costs, where bronze plans typically offer the lowest premiums; silver plans provide moderate costs, gold plans offer reduced expenses, while platinum plans have higher monthly premiums.
Remember, if your income exceeds 400% of the federal poverty level, premium subsidies or cost-sharing reductions won’t apply when purchasing an Obamacare plan on the marketplace. However, non-ACA compliant plans may still offer more affordable and convenient coverage solutions than Obamacare plans.
Pre-Existing Condition Coverage
Under the Affordable Care Act (ACA), insurance companies cannot discriminate against you or charge more based on a preexisting condition, including any health issue you had prior to purchasing a policy; pregnancy and childbirth also count.
Before the ACA was passed into law, individual-market insurers typically required applicants to fill out extensive medical questionnaires about their past medical treatment history. It was common for those with significant preexisting conditions such as cancer to either be rejected from coverage altogether or charged more.
As of today, all individual market plans sold through an exchange are guaranteed coverage for preexisting conditions as are most family major medical policies sold outside. Furthermore, individuals whose income falls within 400% of poverty no longer face penalties for not having insurance; however each company still retains some discretion on what and how much coverage it provides; shopping around is key!
