On March 23, 2010, President Barack Obama signed the Affordable Care Act, commonly known as Obamacare, into law. It seeks to make healthcare more affordable and accessible for all Americans.
The law offers people with low incomes financial assistance to reduce their premiums and out-of-pocket expenses. It also benefits individuals living with preexisting conditions.
Open Enrollment Period
Open enrollment is a time period each year when you can enroll in or switch your health insurance plan. You may also qualify for coverage outside open enrollment if you experience certain life events like losing other health coverage or changing jobs.
Open enrollment is the time to shop for health plans from either the Affordable Care Act marketplace or your employer. You can pick a plan that meets both your health care needs and budget, including deductibles, coinsurance fees and premiums.
Which plan you select depends on your health care requirements, budget and personal preference. For instance, if you do not anticipate any health issues this year, a high-deductible health plan could be ideal for you.
However, you shouldn’t just pick a plan that meets your needs; make sure it also fits within your budget and is suitable for your family. Furthermore, selecting the correct plan could potentially help save money if you qualify for tax credits or subsidies.
Special Enrollment Period
The annual open enrollment period is designed to provide Americans with a convenient opportunity to enroll in health insurance. Unfortunately, life can sometimes intervene and people may need to make changes outside of open enrollment.
This is where the Special Enrollment Period comes in handy. It allows you to enroll or change your existing coverage at any time, even if you don’t have an ACA-compliant plan (on or off the exchange).
There are several qualifying events that can qualify you for a special enrollment period. These include getting married, having or adopting a child, and beginning or ending your employment.
Other situations which could necessitate a special enrollment period include losing employer-sponsored or COBRA coverage, adding a dependent, and losing Medicaid eligibility. Furthermore, an error in policy information display or receiving an appeal decision in your favor may qualify you for such an extension.
Employers will be delighted by this special enrollment period, which helps them avoid ACA penalties. Furthermore, the Inflation Reduction Act extended Premium Tax Credits (PTCs), providing much needed assistance to more insured Americans.
Qualifying Life Events
A Qualifying Life Event (QLE) is an event in your life which may qualify you to enroll outside of Obamacare’s open enrollment period. Examples of such changes can include changes in family size, pregnancy, or income level.
Gwen, a 46-year-old single mom of three boys from Raleigh, North Carolina, accepts an opportunity to oversee a large sales force in Los Angeles. However, her current health insurance plan doesn’t provide coverage there so Gwen opts to switch plans.
Losing health insurance coverage is often the first qualifying life event experienced by many. This can occur when an employee’s coverage is lost due to job loss or termination, or when a dependent no longer qualifies for COBRA coverage due to their parent’s death.
If you have a qualifying life event, Access Health CT offers Special Enrollment Periods where you can sign up for coverage. Usually, you have 60 days after the qualifying life event date to enroll in an Access Health plan.
Medicaid
Medicaid is a state-run health insurance program for low income individuals and families that was expanded under the Affordable Care Act (ACA). It’s designed to cover people with disabilities or low incomes who do not have other coverage options available, as well as those without disabilities who do have health coverage options.
Individuals qualify for Medicaid based on their financial situation and healthcare needs, as well as other non-financial criteria like household size, income level, disability status, family status and more.
Most Medicaid enrollees receive their medical services through community health centers and safety-net hospitals, but some people with complex needs may be enrolled in private managed care plans that contract with states to offer comprehensive services. These plans offer cost-effective delivery methods and help control expenses – particularly for Medicaid populations living with chronic health conditions.
Many states also provide a “spend down” method for those eligible individuals whose incomes exceed their state’s regular Medicaid eligibility limit. Under this plan, they pay non-covered medical expenses until their disposable income drops below the level that qualifies them for Medicaid coverage.
