Topics:Buying health insurance health care Open Enrollment health insurance guides Health and wellness Medicare research
May 7th, 2021
May 7th, 2021
Last week, a special enrollment period for health insurance was announced for states that use HealthCare.gov as their health insurance marketplace. Some states that do not use HealthCare.gov have decided to open their own marketplaces, too. HealthCare.gov will be open for enrollment February 15, 2021 through August 15, 2021. (The enrollment period was recently extended.) Plans purchased during this period will likely be effective starting the month after you make a selection. During this enrollment period, you can enroll in a Marketplace health plan or change to a different Marketplace health plan. (States opening their own enrollment periods may have different dates and possible actions.) You can enroll or make changes three ways: Online through HealthCare.gov Over the phone with the Marketplace call center Through direct enrollment channels (e.g. working with a licensed insurance agent certified by the Marketplace) Louise Norris Health Insurance Expert Expert Tip People should seek out help if they feel unsure of the process. It's important to find a navigator, enrollment counselor, or broker who is certified by the exchange. In HealthCare.gov states, people can use this tool to find local help; the state-run exchanges have similar tools. Typically, you can only enroll in health insurance during the annual open enrollment period (November 1 through December 15). To enroll at any other time, you have to qualify for a Special Enrollment Period by experiencing a Qualifying Life Event. This recently announced special enrollment period offers a valuable opportunity to ensure that you have the health coverage you need. Tips for navigating the special enrollment period If you missed open enrollment, here's your chance to enroll in the coverage you need. Having health insurance can bring peace of mind at any time. However, the peace of mind a health plan offers is only heightened during a pandemic. As you evaluate health plans, pay attention to cost and coverage. Cost Health plan costs include the monthly premiums and out-of-pocket expenses. First, let's talk about premiums. These expenses need to fit your monthly budget so you can maintain your coverage. Subsidies on premiums are available with Marketplace plans. These subsidies are based on your income. When you apply for coverage through the Marketplace, you'll be able to check your eligibility for subsidies. Using these subsidies can make buying a health plan more affordable. With the economic uncertainty and significant changes people are experiencing, anticipated income can be harder to estimate as you determine whether or not you'll qualify for a subsidy. Norris notes how job loss and stimulus checks have posed some difficulty when estimating income: "It's important to understand that unemployment benefits, including the extra federal benefits that were provided last year and again in the bill that was enacted in December, are counted as income when subsidy eligibility is determined." In addition to ensuring that the monthly premium fits your regular budget, consider the plan's out-of-pocket costs. Health plans have an annual deductible that must be met before the insurer begins taking more responsibility for costs. Health plans also have an annual out-of-pocket maximum. This maximum is usually higher than the annual deductible. If you reach your out-of-pocket maximum, the health insurer will take responsibility for covered health care services. As you consider the deductible and out-of-pocket limits, look at the amounts for copays and percentages for coinsurance. These costs are usually paid at the time of service, so they're important to keep in mind. Depending on your health needs, it can make sense to pay a higher premium for better cost-sharing and lower out-of-pocket costs. Coverage Most health plans available offer coverage per Affordable Care Act requirements. Coverage includes mental health services, hospitalizations, preventive care, maternal care, newborn care, prescriptions, and more. However, short-term and indemnity health insurance plans do not offer the same level of coverage. These plans often cover significantly fewer health services and don't cover pre-existing conditions. As you navigate this enrollment period, make sure you're looking at health plans offering full coverage. "It's also important to avoid scammy websites and sales entities that might try to piggyback on this special enrollment period in order to sell short-term plans, fixed indemnity plans, etc. People should start at HealthCare.gov, on the "get coverage" page. When they select their state, it will either keep them on HealthCare.gov or direct them to their state's marketplace, whichever is applicable. That way they'll know for sure that they're shopping in the official marketplace for their state," recommends Norris. As you consider health plans, understand the coverage offered and pay attention to costs to help you find a plan that meets your needs. Implications of the special enrollment period The special enrollment period will affect health insurers and uninsured or underinsured Americans. Health insurance industry Lesa Votovich, GBA Health and Benefits Vice President for Cowden Associates, Inc. observes that health insurers have responded positively to the special enrollment period: "I would say it is welcomed mostly due to the fact that leaving individuals uncovered in general is not good for our society as a whole. It is important for individuals to have access to coverage and to obtain the care that they need. The delay in care often leads to more adverse, higher cost medical events for individuals." Better health insurance coverage within a population can result in better health outcomes, reduce the necessity for expensive care, and protect people financially. During this special enrollment period, many Americans will be able to enroll in a health plan, which also helps insurers manage risk. "From a business perspective in insurance the law of large numbers applies, i.e., the more people you have insured, the more revenue you have to offset the expense and to level premiums against thus keeping insurance premiums in check," continues Votovich. In other words, more people enrolling in health insurance helps to keep premium rates reasonable. Of course, the number of people insured isn't the only thing that affects premium rates, but it does play a role. How much this special enrollment period will affect health insurers depends on how people respond: "Overall, I think the true impact on the health insurance industry will be determined based on how the numbers increase and the actual level of risk that exists within those that do enroll," says Votovich. Uninsured and underinsured Americans According to Kaiser Family Foundation research, having health insurance plays a key role in health care access in the United States. This special enrollment period can help many Americans overcome a major health care access barrier by getting needed coverage. Yet, simply having health insurance may not always translate to health care access for everyone. While acknowledging the importance of having health insurance, Nicole Rochester, MD and founder of Your GPS Doc, LLC also underscores how problems with the health care system affect health care access: "There are many structural barriers that prevent marginalized communities (even those with insurance) from accessing appropriate health care and those barriers will also need to be addressed. Getting health insurance is a first and necessary step, and I’m hopeful that we will see additional improvements moving forward." Taking advantage of this special enrollment period? Here are helpful resources to help you assess health plans and health insurance carriers: 4 Things to Look For in a Health Plan [Video] Aetna vs. Cigna vs. Kaiser Permanente 2021 Review 66% of BlueCross BlueShield Reviews Are 4 or 5 Stars Best Health Insurance Companies: What 2020's Customer Reviews Reveal [Video] Top Health Insurers According to Customer Reviews
A special enrollment period is running from February 15, 2021 to August 15, 2021 in many states. If you don't have coverage, you can enroll in a health plan. Learn more about this special enrollment period. 54 percent. That's the percentage of Americans who don't know their health insurance options if they were to lose their coverage according to a recent study by HealthInsurance.com. If you're in that 54 percent, read on to learn more about your options for getting the coverage you need to defray health care costs. If you didn't have health insurance through your job and want to have coverage just in case, you'll also learn about health insurance options that may be available to you. In addition to reviewing your health insurance options if you lost employer-sponsored coverage or didn't have any health coverage, I'll also summarize how legislation in response to COVID-19 has affected health care coverage: I had insurance through my former employer. I did not have insurance through my employer. I want to learn about legislation responding to COVID-19 and its effect on medical expenses. I had insurance through my former employer. Normally, you can only enroll in a health coverage during open enrollment. However, a qualifying life event triggers a special enrollment period. Because you lost your health coverage when you lost your job, you qualify for a special enrollment period. This allows you to enroll in a health insurance plan even though it may not be open enrollment. Special enrollment periods end 60 days after the qualifying event. If your spouse has health insurance through their employer, you can work with their human resources department to be added to be added to your spouse's insurance plan during your special enrollment period. You can also choose to extend your former employer's coverage through COBRA, buy private health insurance, or buy an Affordable Care Act plan through the health insurance marketplace. If these plans aren't a good fit, you can explore alternatives. These options include short term health insurance, health care sharing ministries, and government-funded plans. To learn more about these, jump ahead to "I did not have health insurance through my former employer." For more on Special Enrollment Periods, read "[Infographic] 5 Questions to Ask About Special Enrollment Periods". COBRA COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It allows you to continue your employer coverage for 18–36 months. To be eligible for COBRA the following must apply: Your former employer must have had at least 20 employees for more than half of its business days last year. You were terminated, but not for gross misconduct. Or, your hours were reduced. If you're a dependent of someone who lost their job or now has reduced hours, you also qualify for COBRA coverage. Dependents are also eligible for COBRA if the employee becomes eligible for Medicare, in situations of divorce or legal separation, and if the employee passes away. If you choose to enroll in COBRA continuation coverage, you'll take full financial responsibility for participating in the health plan. The employer contributions will become your responsibility. "If someone loses their job because of COVID-19, they should first figure out when their health insurance will run out and what COBRA will cost them. COBRA is typically prohibitively expensive, but may be worthwhile if you have special or extensive health care needs or existing health care relationships you need flexibility to maintain," Deborah Gordon, The Health Care Consumer’s Manifesto author. Your former employer is legally obligated to provide you information on COBRA and enrollment. You typically have 60 days from when you receive the election notice or lose coverage, whichever is later to decide whether to enroll in COBRA. COBRA can also be retroactive, so if you do not enroll and need medical care within the 60-day election period, you can enroll, pay past premiums, and have coverage. You can enroll yourself or your dependents separately in COBRA. Each eligible person must make an election to be covered through COBRA. For more information on COBRA, read the Department of Labor's helpful FAQ. Private insurance Insurers can offer plans that do not meet the Affordable Care Act guidelines. Because these plans don't have to cover everything Affordable Care Act plans do, you may be able to find a plan that offers the insurance coverage you need at a lower price. These plans can have a lot of variability, so you need to carefully review what's covered and what isn't along with the premiums and out-of-pocket costs. Private insurers also offer off-exchange plans that do meet Affordable Care Act guidelines. These plans are not listed on your state's health insurance marketplace and are not eligible for premium-subsidies. However, they still offer comprehensive coverage. Working with an independent insurance agent can help ensure that you find a plan that meets your needs. Affordable Care Act plans If you visit HealthCare.gov, you can view the Affordable Care Act plans (also called Marketplace plans) available in your area. Depending on your financial circumstances, you may be able to qualify for a subsidy on monthly premiums. Marketplace subsidies make the monthly premium more affordable by giving you an advance tax credit. If you took too much or too low of a subsidy, the balance is adjusted when you file your tax return. Affordable Care Act plans do not have exclusions for pre-existing conditions and provide comprehensive coverage for health care services. If you're in good health and are under 30, you may be able to opt for a catastrophic insurance plan. These plans have low premiums and high deductibles. These plans are designed for people who don't have medical concerns and mainly need coverage for emergency situations. Compare Health Insurance Companies Learn more about health insurers and their offerings by looking at the top-rated companies and their customer reviews. Learn More Back to Contents I did not have insurance through my former employer. If you did not have health insurance through your former employer, you'll have to wait for the next open enrollment period to enroll in a typical health plan. However, some states have opened statewide special enrollment periods because of COVID-19 concerns. Do a quick Google search or check this helpful HealthInsurance.org article to see what your state has done. If your state has opened a special enrollment period, review the options in the "I had insurance through my former employer." If not, the options below are still available to you. Short-term health insurance Short-term plans can be bought year-round. These plans offer coverage for doctor visits and emergency room services. In some cases, they may even offer some coverage for prescriptions. These plans are very limited because they do not cover pre-existing conditions. Once your current short-term plan ends, any medical issue that occurred within that time frame is a pre-existing condition when you renew or buy another plan. Some states do not allow short-term plans If you just need some coverage to get you through, a short-term plan can be a great health insurance option. Just be sure to pick the longest term length you need in case any medical issues arise. For expert advice on short-term health insurance, read Short-term Health Insurance: 5 Questions You Should Ask Before You Buy Short-term Health Insurance: What Top Companies Offer Indemnity health plans You can also buy indemnity health plans without needing an enrollment period. These plans offer set benefits for specified health care services. You'll be responsible for paying your health care provider and making claims with the insurance company. "An indemnity plan may pay a maximum of $3,000 per day for a day in the hospital or maybe $5,000 a day, some only pay $300–$400 per day. So you have to really understand how they work. It can be a great value, but education is crucial," says Eric Wilson, Principal of Wilson & Associates. Understand what the fixed payments are for claims and check what services are covered. You'll also want to pay attention to coverage exclusions. Like short term health insurance, indemnity plans typically do not cover pre-existing conditions. Health care sharing ministries Another alternative to health insurance are health insurance ministries. Health care sharing ministries are usually connected to religious groups and expect members to live religious, low-risk lifestyles and be healthy. These are attractive, especially to people in good health, because the monthly premiums are usually lower than health insurance. Laura Handrick, Choosing Therapy contributing HR professional, shares her experience with a health care sharing ministry: "After extensive research, we chose a health share instead of insurance. The costs of these programs run 50–75 percent less than traditional healthcare. For just over $400 per month, we have access to low-cost medications, free telehealth, and affordable medical visits. Catastrophic health issues are covered, often at higher rates than traditional insurance." While these ministries can offer valuable coverage, realize that health care sharing ministries aren't technically insurance. They do not have the same legal obligations as insurers. Do thorough research because covered services vary. For more information on health care sharing ministries, read HealthInsurance.org's health care sharing ministry overview. Government-funded plans The government funds several programs to help specific demographics access health care. Most people become eligible for Medicare when they turn 65. However, there are other eligibility criteria that allow people to qualify sooner with certain diagnoses like End-Stage Renal Disease. Medicaid eligibility is primarily determined by income. In some cases, you may qualify because of disability or significant medical needs. Check your state's Medicaid policies even if you think you won't qualify. Some states have expanded Medicaid to increase access. "Some people may qualify for Medicaid, the public insurance program for lower-income people. In some areas, not as many doctors or health care providers accept Medicaid, but, to cover you in a gap, it may be worth signing up. It is usually free or very low cost if you qualify, and the benefits are mandated and comprehensive," says Gordon. The Children's Health Insurance Plan (CHIP) provides health insurance for children who do not qualify for Medicaid, Medicare, or have other insurance options. If you don't qualify for Medicaid coverage, you may be able to get coverage for your children through this program. Telemedicine subscription services Telemedicine services are not health insurance. However, if an insurance plan isn't an option for you, buying a telemedicine subscription can make it easier and more affordable to receive non-emergency medical diagnoses and medical advice. Telemedicine apps work differently. Some are subscription-based and allow a certain number of virtual visits per month. Others are fee-based and charge a set fee for each virtual visit. As you compare telemedicine services and costs, be sure to check that the application's security is HIPPA-compliant. Telemedicine is especially helpful right now as clinics and hospitals have instituted protocols and restrictions to prevent the spread of COVID-19. Having access to medical professionals through telemedicine can help offer you peace of mind. For more on telemedicine, review: Telemedicine: What You Need to Know What to Expect from Telemedicine Yes, You Can Get Health Care While Social Distancing Compare Health Insurance Companies Learn more about health insurers and their offerings by looking at the top-rated companies and their customer reviews. Learn More Back to Contents I want to learn about legislation responding to COVID-19 and its effect on medical expenses. Several pieces of legislation have been passed in response to COVID-19 including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act. "A key focus of the CARES Act is the adoption of a variety of measures designed to expedite the approval and availability of drugs and devices needed to fight the pandemic, to shore up the financial positions of hospitals and other healthcare providers facing unprecedented demands, and to temporarily relax restrictions that may make it more difficult for patients to obtain access to needed testing and care," says Roger Milliner, MetroPlus Health Plan Chief Growth Officer. Federal legislation has responded to the many different types of needs created by the current crisis throughout the United States. States have also taken independent action to respond. We'll focus on federal changes specifically related to health care and health insurance. These governmental changes have made accessing telemedicine easier. "The CARES Act expands telemedicine so that healthcare providers and consumers can speak over the telephone, Skype, or Facetime to conduct a medical appointment. Telemedicine allows for diagnosis and a treatment plan to be developed over the phone, and the doctor can order labs or prescriptions as needed. This ease and efficient use of technology is typically a much more cost-effective solution that can help people who are uninsured receive reasonably priced treatment.” says Jan Dubauskas, healthinsurance.com Vice President. The CARES Act also expanded how Health Savings Accounts (HSAs) can be used to include telemedicine, over the counter drugs, and menstrual products. Some insurers also made adjustments to cover telemedicine visits the same way they cover in-person visits on plans that did not include coverage for telemedicine. As far as handling COVID-19 health expenses, the Families First Coronavirus Response Act and the CARES Act have made managing those costs easier for people with and without health insurance. If you do not have health coverage, the Provider Relief Fund will be used to pay eligible hospitals at Medicare rates for treating uninsured COVID-19 patients if they do not do balance billing for all COVID-19 treatment. If you have health insurance, your insurer is required to cover your cost-sharing payment for COVID-19 testing. The Trump administration has also negotiated with well-known health insurers like Cigna and United Health Group to have cost-sharing payments waived for all COVID-19 treatment costs. The CARES Act also incentivizes providers to bill all COVID-19 treatments at in-network rates with payments. "The CARES Act will make payments to certain providers if they agree to treat all COVID-19 patients with a preferred payment schedule as in-network patients, keeping costs down for patients whose coverage is out of network," says Dubauskas. Even with these legislative measures in place, your hospital may not qualify for or seek these incentives. If you get an unexpected bill, ask questions about the CARES Act and what payment options exist. In some cases, it may be helpful to seek a lawyer's advice. "In the worst case, if you don’t qualify for lower-cost insurance and you can’t afford to buy private coverage, you can wind up with a hefty medical bill if you get sick with COVID-19 or otherwise. In that case, negotiate! Ask for a payment plan. Seek forgiveness for the medical debt. No matter what, though, get care if you need it, and sort out the finances when you can," recommends Gordon.
Updated October 27, 2020 Maybe you just finished college and are navigating health insurance for the first time. Maybe you're buying your own coverage as a student. Maybe you just lost your employer-provided health insurance. Whether you just need a health insurance refresher or you are just getting your feet wet, I've collected the best resources the internet has to offer on the following topics: Health insurance and COVID-19 Understanding health insurance Terms to know How health insurance works Medical bills Types of health plans Marketplace (ACA, on-exchange) plans Private insurance (off-exchange) plans HSAs, FSAs, HRAs COBRA Medicaid and CHIP Medicare Student health insurance Catastrophic plans Short term plans Enrolling in health insurance Open enrollment Special enrollment Finding affordable health care FAQs Small businesses owners I'll continue to update and add new resources to this page. If you think there's a resource missing, let me know. Health insurance and COVID-19 updates COVID-19 has changed the everyday life of most Americans. Local, state, and federal governments have made changes to address this crisis. These changes have affected health insurance and health care. How to Get Health Insurance If You're Worried About Coronavirus or Have Lost Your Job — New York Times State and Federal Efforts to Improve Access to COVID-19 Testing, Treatment (notes states with special enrollment periods) — HealthInsurance.org What Will Health Insurance Cover for COVID-19? — eHealth Yes, You Can Get Health Care While Social Distancing — Best Company Telemedicine: What You Need to Know — Best Company Coronavirus Disease (COVID-19) Resources for Older Adults, Family Caregivers and Health Care Providers — The John A. Hartford Foundation CDC Updates and Guidance — Centers for Disease Control and Prevention Back to Menu Understanding health insurance Health insurance has its own language, terms, and definitions. The jargon can make choosing a plan and understanding medical bills difficult. Luckily, many websites have put together resources to explain terms and how insurance works. Terms to know 24 Health Insurance Terms Explained in Plain English — Vice Health Insurance Glossary: Your Guide to Terminology — UPMC Health Beat Cracking the Code: 14 Health Insurance Terms You Should Know — Bedside.org Acronym Exasperation: An Explanation of Common Health Insurance Acronyms — Best Company How health insurance works Health Insurance Explained: The YouToons Have It Covered (video) — Kaiser Family Foundation Health Insurance 101 — The Paper Gown Understanding Health Insurance — MedicalBillingandCoding.org Copay vs Deductible: How Does Insurance Work? — Aeroflow Healthcare Medical bills Understanding Healthcare Reimbursement — Verywell Health Understanding Medical Bills — MedicalBillingandCoding.org Understanding Your Medical Bills — FamilyDoctor.org Paying for Medical Care — USA.gov How to Negotiate a Surprise Medical Bill — AARP How to Appeal a Rejected Claim — WebMD Back to Menu Types of health plans Another reason it's easy to be overwhelmed by health insurance is the many types of plans available. Below are the top resources on health plans created for specific demographics. Plans within the categories listed below can also vary by type of network and cost-sharing structure. Marketplace (ACA, on-exchange) plans Private insurance (off-exchange) plans HSAs, FSAs, HRAs Medicaid and CHIP Medicare Student health insurance Catastrophic plans COBRA Short term plans Back to Menu Marketplace (ACA, on-exchange) plans What You Should Know About the Affordable Care Act — Verywell Health 11 Things to Know About Affordable Care Act Open Enrollment — AARP Back to Types of Health Plans Private insurance (off-exchange) plans Private Plans Outside the Marketplace Outside Open Enrollment — HealthCare.gov How to Find Private Health Insurance — Medical News Today Back to Types of Health Plans HSAs, FSAs, HRAs HSAs (Health Savings Accounts) What Is a Health Savings Account (HSA)? — Dave Ramsey Blog 7 Tips to Choosing the Best HSA Account — Bankrate HSA Basics — Benefit Resource, Inc. 6 Answers to Common HSA Questions — PeopleKeep HSAs: The Secret IRA Nobody Is Talking About — The College Investor Take Advantage of the HSA Loophole — Forbes The Truth About HSAs and Retirement — Betterment 4 HSA Mistakes to Avoid in 2020 — The Motley Fool The Best Ways to Use an HSA — The White Coat Investor FSAs (Flexible Spending Accounts) If You Have Access to an FSA or HSA, Here’s Why You Should Sign Up for One This Year — CNBC What Is a Flexible Spending Account? — Clark.com History of Flexible Spending Accounts (FSAs) — PeopleKeep HRAs (Health Reimbursement Arrangements) Health Reimbursement Arrangements: How an HRA Works — ConnectYourCare Health Reimbursement Arrangements (HRAs) — IRS.gov The Difference Between HRAs and HSAs — PeopleKeep What’s the Difference Between an HSA, FSA, and HRA? — Self.com Back to Types of Health Plans Medicaid and CHIP Medicaid and CHIP Coverage — HealthCare.gov What Everyone Needs to Know About Medicaid — Bankrate How to Apply for Medicaid and CHIP — USA.gov Children's Health Insurance Program (CHIP) — Medicaid.gov CHIP Program Name and Type — Kaiser Family Foundation A Guide to Medicaid: Eligibility, Enrollment and What It Covers — HelpAdvisor Back to Types of Health Plans Medicare What Are the Parts of Medicare? [Infographic] — Best Company Basic Differences Between Medicaid and Medicare — Bankrate Medicare.gov Medicare Benefits — Social Security Administration Medicare Terms and Definitions — The Healthy Most Popular Medigap Plans Won’t Be Available to Some New Enrollees in 2020 — AARP 5 Questions to Ask About Medigap — Best Company Understanding Your Health Care Needs — MedicareMadeClear.com 3 Expensive Misunderstandings of Medicare — Forbes Understanding Medicare's Hospice Benefit — Elder Law Answers Medicare and Mental Health: 4 Key Things to Know — Best Company Back to Types of Health Plans Student health insurance In School? Student Health Plans and Other Options — HealthCare.gov The Student's Guide to Health Insurance — BestColleges.com College Student Guide to Choosing Health Insurance Plans — AffordableCollegesOnline.org Student Health Insurance: Required Reading — HealthInsurance.org An FAQ About Health Insurance for Students — Vice Should I Buy the Health Plan My College Offers? Or Buy Through an ACA Exchange? — HealthInsurance.org Back to Types of Health Plans Catastrophic plans How to Pick a Health Insurance Plan: Catastrophic Health Plans — HealthCare.gov What Is Catastrophic Health Insurance, and Is It Worth It? — The Motley Fool What Is the ACA's Catastrophic Plan and Who Is Eligible? — HealthInsurance.org Back to Types of Health Plans COBRA Continuation of Health Coverage (COBRA) — Department of Labor What Is COBRA Insurance? — Dave Ramsey Do You Still Need COBRA Health Insurance? — HealthInsurance.org Is COBRA Insurance the Best Option for People Between Jobs? — HealthSherpa How to Get COBRA Health Insurance If You Lose Your Job or Retire Early — Business Insider Back to Types of Health Plans Short term plans ACA Open Enrollment: For Consumers Considering Short-Term Policies — Kaiser Family Foundation Is Short-Term Health Insurance Right for You? — HealthInsurance.org What to Know Before You Buy Short-Term Health Insurance — New York Times Warning: Short-Term Health Plans = Higher Premiums for Older Adults — AARP Short Term Health Insurance: 5 Questions You Should Ask Before You Buy — Best Company Short Term Health Insurance: What Top Companies Offer — Best Company Back to Types of Health Plans Back to Menu Enrolling in health insurance To enroll in health insurance, you need to pick a health plan. If you want a health plan that offers comprehensive coverage, you'll also need to understand enrollment periods. Outside of enrollment periods, you cannot buy comprehensive health plans. Health plan evaluation 5 Questions to Ask Before Signing Up for Health Insurance — Best Company 3 Things to Know Before You Pick a Health Insurance Plan — HealthCare.gov 4 Things to Think About When Choosing Your Health Plan — PhRMA Tips for Choosing a Plan — ConnectforHealthCO 10 Helpful Hints for Choosing a Health Insurance Plan — Cancer.net 4 Things to Look For in a Health Plan [Video] — Best Company Open enrollment 4 Ways to Prepare for Open Enrollment — Best Company Open Enrollment for Families — HealthMarkets ACA Open Enrollment If You Shop on Private Websites Instead of HealthCare.gov — Kaiser Family Foundation ACA Open Enrollment If You Are Low Income — Kaiser Family Foundation How to Save Money During Open Enrollment — Bankrate What to Do If You Miss Open Enrollment — Best Company Special enrollment periods Enroll in or Change 2020 Plans — Only with a Special Enrollment Period — HealthCare.gov FAQ of the Week: Who Qualifies for a Special Enrollment Period? — CHIRblog Understanding Special Enrollment Periods — CMS Health Insurance Marketplace [Infographic] 5 Questions to Ask About Special Enrollment Periods — Best Company Back to Menu Finding affordable health care Finding Health Insurance — USA.gov These 6 Resources Will Help the Self-employed Find Affordable Health Care — The Penny Hoarder If I Can't Buy a Short Term Plan and I Don't Have a Qualifying Event, What Are My Coverage Options? — HealthInsurance.org Best Health Insurance Companies (customer reviews) — Best Company Back to Menu FAQs FAQs: Health Insurance Marketplace and the ACA — Kaiser Family Foundation Frequently Asked Questions About Health Insurance — HealthInsurance.org Get Fast Answers to Your Health Insurance Questions — HealthCare.gov COBRA and State Continuation — Frequently Asked Questions — DataPath Back to Menu Small businesses owners Exploring Coverage Options for Small Businesses: Health Insurance for Businesses — HealthCare.gov Unpacking Health Insurance Basics for Small Businesses — Workest 5 Steps for Choosing the Best Health Insurance Plan for Your Small Business — TheSelfEmployed.com The Top 5 Small Business Health Insurance Options in 2020 — PeopleKeep Health Insurance Reimbursements: What Are the Options? — PeopleKeep Small Business Health Care Tax Credit: Questions and Answers — IRS.gov Open Enrollment Guide and Resources: How to Communicate with and Help Employees to Choose Workplace Benefits — SHRM Surviving Open Enrollment: A Four-Step Health Insurance Guide for Small Businesses — business.com
Read our customer review report for 2020: "What Health Insurers Are Doing Right: 2020's Customer Reviews" Your health matters. It directly affects your quality of life, ability to work, and longevity. Health insurance is key to many people’s ability to access the health care they need, but accessing health care isn’t always easy even with insurance. Because health is so central to our lives, it isn’t surprising that government policy around health care will be one of many important issues on voters’ minds in November. Whether you’re a health insurance shopper, U.S. voter, or part of the health insurance industry, paying attention to what customers are saying will help you understand the state of the health insurance industry in the United States and identify ways it can be improved. Want to skip to the review data? Jump to the Reviews Analysis Why health insurance matters A recent Freedom Debt Relief study found that affordable health care was the top concern when people ranked current issues in order of importance. Health insurance and health care costs are at the forefront of many Americans’ minds. There is a strong correlation between having health insurance and accessing health care. According to a Kaiser Family Foundation brief on uninsured Americans found that “(43 percent) of uninsured people said they had problems paying household medical bills in the past year and are more likely to have medical debt than people with insurance.” No one should have to make sacrifices in their health to maintain their financial security and avoid debt. But, medical care is expensive, and people are making health sacrifices because of it. Freedom Debt Relief’s study found that only 28 percent of people hadn't skipped doctor or dentist appointment, delayed receiving a procedure, or rationed, found alternatives to, or didn't buy prescriptions. While having health insurance usually increases access to health care, health insurance itself isn’t cheap. The uninsured rate in the United States rose slightly in 2018. Recent changes to health care policy may have had an effect according to a New York Times article. There was less advertising and education due to budget cuts. Subsidies available under the Affordable Care Act were also eliminated. Medicaid enrollment has also been affected by other changes. Moves to request proof of eligibility more frequently and limiting access for those applying for green cards or citizenship likely caused the lower enrollment rates. While the uninsured rate is still low compared to pre-Affordable Care Act levels, limited access to health insurance affects millions of people in the United States. The Kaiser Family Foundation brief found that cost was the main reason adults had for being uninsured. Forty-five percent of uninsured adults reported that cost was a barrier according to the brief. Other barriers to access included no employer-coverage, no Medicaid expansion, and ineligibility for subsidies or lack of knowledge of subsidies. While some of these studies focus on access for U.S. citizens and documented immigrants, undocumented immigrants are not eligible for these programs, so they experience even more barriers when trying to access medical care. Some of these barriers are related to government policy. However, the largest barrier was cost, which begs the question: What are the costs of health insurance that could be lowered to increase access? The Freedom Debt Relief study sheds some light on this question and on what consumers would like to see in their health plans: Lower deductible (54%) Lower monthly payment (44%) Expanded coverage (31%) Coverage for whole family (27%) These consumer insights combined with other studies offer valuable insight into current issues in health care and health insurance. Customer reviews add another dimension to these conversations because they document the challenges people face when dealing with insurance companies. Why customer reviews matter Unfortunately, as valuable as health insurance is, the pasture isn’t necessarily green once you have it. We looked at health insurance customer reviews left on Best Company during 2019 to learn more about the biggest issues people have with health insurance companies. Reviews offer excellent insight into the customer experience because you find stories of how the company treated a customer and the value the customer gives the service rendered. Reviews can help shoppers avoid bad companies and choose good ones. Given that "82 percent of buyers consider user-generated reviews to be extremely valuable," you probably looked at reviews the last time you made a purchase. Reviews can also help companies understand what they’re doing well and how to improve to attract more clients in the future. From an industry-level, reviews also show us the problems within the industry. Identifying the problems is the first step to finding innovative solutions. Health care is a major issue in the United States, and health insurance plays an important role in health care access. Customer reviews are becoming more and more important for consumers and businesses. More customers are reading reviews before making purchases, which helps them understand the quality, value, and what to expect from their purchase. Bad reviews are bad news for businesses, so it’s tempting to pay for good reviews or repress bad ones. Companies sometimes pay for fake reviews. Companies also incentivize customers to leave reviews. While these reviews may not be fake, incentives increase motivation for fake reviews and even the real reviews may not genuinely reflect the customer experience. In some cases, companies may be able to work with a review website to stop publishing bad reviews. Even if it’s tempting to pay for good reviews or to repress bad reviews, businesses can use better methods like responding to them. Because review guidelines are not standardized across the industry and there are unethical practices in use, consumers need to understand a review site’s policies and practices regarding review publication. While this review analysis is limited to Best Company reviews, it contributes valuable information to the broader discussion of health care access and health insurance. Best Company vets each review submission before publication to ensure that the review is genuine, not fake. It also publishes all genuine reviews — good and bad. While analyzing reviews from Best Company yields a more accurate representation of the customer experience, there are a few limitations when analyzing 1-star reviews in aggregate. Best Company has 62 health insurance companies listed. Reviews (including 1-star reviews) are not evenly distributed between the companies. Some companies even have no reviews. Companies also have different splits among 5-star, 4-star, 3-star, 2-star, and 1-star reviews. Companies with a higher proportion of 1-star reviews may skew the broader analysis. However, even though some companies may have fewer 1-star reviews, understanding the difficulties people experience with health insurance regardless of the company is valuable information for anyone trying to make health insurance better and anyone shopping for health insurance. While there are some limitations related to sample size and scope, because Best Company verifies the reviews that come in and publishes all genuine reviews this analysis gives a good picture of how customers experienced the health insurance industry in 2019. Health insurance reviews analysis Overall, the review breakdown of the total 1066 reviews was 28 percent 5-star reviews, 18 percent 4-star reviews, 8 percent 3-star reviews, 5 percent 2-star reviews, and 41 percent 1-star reviews. The combined total of 5-star and 4-star reviews helps paint a more hopeful picture of the industry. However, using these ratios to calculate a weighted score gives health insurance companies a 2.9 user star-rating on Best Company. In other words, there’s room for improvement. 1-star review analysis When we analyzed the 1-star reviews, complaints fell into the following categories: 42 percent of reviewers mentioned poor customer service 32 percent of reviewers mentioned coverage approval difficulty or denial 23 percent of reviewers mentioned claims process and payment difficulty 22 percent mentioned provider network satisfaction 21 percent talked about the cost vs value of the insurance plan 13 percent of reviewers mentioned company errors 7 percent referenced coverage misrepresentation 5 percent said they would have given a lower rating 4 percent sought additional help by filing formal complaints, getting an attorney, etc. Reviewers mentioned as many as four of the above issues. Some mentioned fewer. The average length of a 1-star review was 117 words, while the average word count for a 5-star review was 42 words. When people had bad experiences, they had on average more than twice as much to say and typically mentioned more than one problem. Poor customer service If you’ve ever had an unfruitful or difficult interaction with a customer service representative, it’s no surprise that this complaint tops the list. Reviewers that complained about customer service mentioned poorly trained representatives, getting the runaround, not getting the help they needed for finding a provider or enrolling, and getting conflicting information. While you can find similar customer service complaints in almost any industry, poor customer service in health insurance can affect people’s finances and health in important ways. Coverage approval difficulty or denial Reviewers who had difficulty getting prescribed medicine and treatment approved talked about how the delays with the process and denials affected their health. These reviews were the hardest to read. Unfortunately, these difficulties aren’t surprising. Health insurance adjusters will look for cheaper treatment alternatives and may not always consider the unique circumstances, like allergies or negative side-effects associated with some drugs. Some treatments, procedures, and surgeries are considered experimental, and insurance companies don’t always cover those because they have not yet become a widely accepted treatment. It’s also important for insurance shoppers to realize that health plans have different rules regarding coverage and cost-sharing. You’ll want to carefully evaluate health plans with a trusted insurance agent to be sure that you understand the caveats and what the plan may not cover. Claims process and payment difficulty Some reviewers had difficulty using making premium payments either online, via phone, or with a check. While these payment difficulties are troublesome and can lead to loss of coverage, they are easier to fix and were mentioned less frequently in comparison to difficulties with the claims process. Reviewers who had difficulty with the claims process were frustrated as they had to go back and forth between their provider and the insurance company. In some cases, claims weren’t paid or were denied because of a company error or an error in coding the health service received. Resolving these issues was not easy for most people. No one enjoys dealing with a difficult claims process, especially when they’re recovering from treatment or caring for a recovering family member. An insurance company’s failure to pay claims also resulted in doctors stopping acceptance of the company’s insurance plans. Provider network satisfaction Health plans typically come with specific provider networks. Seeing in-network care providers tends to be cheaper for you and the insurer. Some plans offer coverage for out-of-network care. Although typically more expensive for you, having flexibility when choosing providers is nice. Complaints about the provider network included a doctor’s bedside manner and interactions with patients and the difficulty of finding a network doctor nearby. Some complaints mentioned the insurance company’s failure to update its provider lists, which made it harder for plan members to find network doctors to get the treatment they needed while getting the most value from their plan. Cost vs. value While many factors affect the value of a health plan and a customer’s experience of value, not all reviewers explicitly referenced a disproportionate relationship between the cost of a plan and its value. Cost usually referenced the monthly premiums. Value represents the coverage and cost-sharing customers received. Reviewers felt that the premiums were higher than the coverage and cost-sharing offered. Company errors Company errors fell into several categories: there were coverage errors, inaccurate billing, policy cancelations that took reviewers by surprise, poor record keeping by the company, incorrect network provider lists, and incorrect information given by company representatives. One reviewer even had difficulty with the prescription delivery service. Some of these errors had an effect on the reviewer’s health. Others mostly affected the reviewer’s finances. What’s most concerning about these complaints is that reviewers noted difficulty working with the company to resolve the errors. It took a lot of effort and consistent communication over time to get errors fixed. In some cases, the errors were not fixed. Coverage misrepresentation Coverage misrepresentation usually resulted from working with a third party or receiving bad information from a company representative. Most of this seems like it could have been unintentional, a result of poor training, or even miscommunication. While the reasons for the disparity between expectations and reality may be relatively benign, the effects on customers were serious because they affected their finances and access to health care in unexpected ways. Lower rating Some reviewers noted that they would have given a lower rating than 1-star if they could have. This came up frequently enough to track it. These comments reflect the deep dissatisfaction that consumers feel compared to what was expressed by other reviewers. Sought additional help A few reviewers felt they had been treated so unfairly that they were considering filing a formal complaint with a government agency or meeting with a lawyer. Several already had taken one of those steps. Where we go from here There are two ways to approach these results: from a company level and from a consumer level. We’ll go over action items for both. Health insurers 1. Provide better training for customer service representatives You can do a better job training their representatives. Training should involve professionalism on the phone and providing reliable information to customers. Well-trained representatives go a long way in improving the customer experience when asking questions and resolving issues. 2. Create a smoother prior authorization process You can evaluate your prior authorization processes to help members achieve better health outcomes. Finding ways to be more efficient with this process will make it easier for members and doctors to work with companies while delivering or receiving the care they need. 3. Revisit your claims process You can review the claims process. First, you need to be reliable in making payments to health care providers. When insurance companies are not consistently reliable, doctors stop accepting plans. Second, find ways to make the claims process easier. What are your protocols for when claims issues arise? Are there processes you can change to make processing claims and dealing with disputes easier? 4. Make it easier to resolve issues and fix errors You can make it easier to catch and correct errors in general. Most importantly, you need to evaluate your processes for resolving errors when they happen. If errors are faster and easier to resolve, they will not be as big of an issue for members who deal with them. 5. Offer robust provider networks You can increase the value their plans offer by maintaining robust provider networks. Plans that make it easier to find in-network providers will help keep members with the company. Part of maintaining a good network includes making timely payments to doctors and hospitals when they make a claim. Consumers 1. Be wary of companies with too many 1-star reviews You should avoid companies with high percentages of 1-star reviews, especially if the reviews are recent and come from people in your area. Reading customer reviews from your area will give you a good sense of how a company treats its clients. If your options are limited to a poorly rated company, you’ll be prepared because you’ll know what difficulties to expect. 2. Check provider networks When shopping for insurance, you should ask your provider if they accept any of the plans you’re considering. If you don’t already have providers, you should look at the network of doctors listed by the health insurer and in-network. Call a few to see if they still plan on participating in the plan’s network. This is extra work on your part, but it will help you know how accurate the provider lists are and give you an idea of how easy it would be to find an in-network doctor. 3. Keep your own records You can also keep your own records of conversations with representatives and enrollment. This documentation can help you resolve errors if they arise, even if the resolution process may be difficult. And, if your challenges need to be escalated to legal action or filing a formal complaint, you’ll already have the documentation to support your case ready. Methodology These results are based on a total of 1,066 health insurance reviews left on Best Company in 2019. Of those reviews, 439 had 1-star ratings. A random sample of 202 1-star reviews is the basis for the complaint analysis. Results of the 1-star review analysis have a 95 percent confidence level with a 5 percent margin of error.
Short-term health plans can be a good option if you need coverage before your health plan kicks in or if you missed the enrollment period. These plans usually have cheap premiums, but their coverage is also more limited compared to more traditional health plans. Short-term health insurance offers the most basic health coverage. It helps with doctor visits, diagnostic tests, and emergency services. These plans are not compliant with the Affordable Care Act. Pre-existing conditions are not covered with these plans. For more information and expert insight on short-term insurance plans, read part one of this series: Short-Term Health Insurance: What You Need to Know. Not all health insurers offer short-term health plans. Only two of Best Company’s top 10 health insurers offer short-term plans. However, there are a few other companies worth considering. We'll review what the following companies offer: BlueCross BlueShield UnitedHealthcare National General The IHC Group Note: Screenshot headings are from April 28, 2020. BlueCross BlueShield BlueCross BlueShield is ranked number two on Best Company. It has earned an overall score of 7.8/10 and a user star rating of 3.6/5. BlueCross BlueShield’s offers short-term health plans through some of its subsidiaries. You’ll need to check with your local subsidiary to see what’s available in your area. For example, BlueCross BlueShield of South Carolina offers short-term plans called Blue TermSM. These plans do not cover pre-existing conditions. They also only offer coverage for visiting in-network providers. You can customize your Blue TermSM plan by choosing the length of time you want covered. You’ll find several plan options for each specified length of time with varying premiums, deductibles, and out-of-pocket maximums. The cost-sharing rules (e.g. coinsurance) also varies by plan. BlueCross BlueShield Customer Reviews Learn more about BlueCross BlueShield by reading customer reviews. Read Reviews Back to Menu UnitedHealthcare UnitedHealthcare is ranked number six on Best Company. It has an overall score of 7.2/10 and a user star rating of 3.1/5. UnitedHealthcare offers two kinds of short-term health insurance plans: Short Term and Enhanced Short Term. These plans can last 30 days to close to a year. Plans are not guaranteed issue plans, so you'll need to go through underwriting for approval. These plans offer coverage for doctor visits, ER care, hospitalizations, labs, and may offer some coverage for prescriptions The Short Term plan is available in 27 states, including Florida, Illinois, and Texas. While there is variability by state, UnitedHealthcare offers three different lifetime maximum benefits that each have a few plan options in a majority of these states. The per-person lifetime maximum benefit amounts are $250,000, $600,000, and $2,000,000. Each option offers choices for the deductible amount. Some also offer coinsurance choices. The level of customization and flexibility is a nice feature of these plans. The Enhanced Short Term plan is available in 19 states, also including Florida, Illinois, and Texas. These plans also vary by state. However, offerings in a majority of states are the Plus Elite, Copay/Direct, Plus/Direct, and Value/Direct plans. Each plan’s cost-sharing rules differ, which allows you to choose what matters most to them in cost sharing. If you prefer lower premiums, you can choose a plan with higher out-of-pocket costs. You can also choose a plan based on how you want to control your out-of-pocket expenses. Some of these plan structures are only available for specific lifetime maximum benefit amounts. Plus Elite, Copay/Direct, and Value/Direct plans are available with the $500,000 per-person lifetime maximum benefit plans. These plans allow you to choose your deductible amount. Plus Elite, Copay, Plus, and Value plans are available with a $2,000,000 per-person lifetime maximum benefit. These plans also allow policyholders to choose their deductible. UnitedHealthcare Customer Reviews Learn more about UnitedHealthcare by reading customer reviews. Read Reviews Back to Menu National General National General has yet to earn a rank on Best Company because there aren't enough reviews to give a score. National General offers short-term plans with Aetna and Cigna PPO networks. Aetna network plans are available in 32 states and Washington, D.C. Cigna PPO network plans are available in 17 states. Plan features vary by state and network chosen. However, I’ll briefly review the options available in the majority of states for both networks. Both Cigna PPO and Aetna PPO network plans include LIFE Associate Membership, which gives you access to telemedicine, pharmacy discount card, negotiators for hospital bills, and wellness perks. Both also offer options to buy renewable plans or consecutive plans. These options may not be available in every state. With the renewable option, you can have some costs covered for pre-existing conditions after the first 12 months. Your deductible and coinsurance reset with each new coverage period, but the maximum benefit does not. If you'd like to lock in your premium rates, you can, but it's not a standard part of the renewable option. With this option you can buy three years of coverage. Buying consecutive plans is similar to the renewable option. The differences are that there is no guaranteed rate option, the maximum benefit resets each period, and you can buy two years of coverage. Plans with Cigna PPO network National General offers two plan options with the Cigna PPO network: Enhanced PPO and Copay PPO. Each option offers different deductible amounts and cost-sharing structures. The maximum benefit, referred to as the coverage period maximum, is $1,000,000 for the Enhanced PPO plans and $5,000,000 for the Copay Enhanced PPO plans. Plans with Aetna PPO network Plans and plan availability varies by state. In a majority of states, National General offers four plans: Essentials PPO Enhanced PPO Copay Enhanced PPO Guaranteed Issue PPO Each of these plans have different coverage period maximums: $250,000, $1,000,000, $5,000,000, and $100,000 respectively. Once you've chosen the kind of plan that best suits your needs, you can choose from available deductible and cost-sharing structure options. Back to Menu The IHC Group The IHC Group has yet to be reviewed by customers, so it does not currently have a score on Best Company. When you visit IHC Group’s website and decide to shop for short-term health plans, you can click on a link that directs you to healthedeals.com. There you can get quotes on short-term health plans. You can filter your quotes by how frequently you want to pay the premium (all at once or monthly) and how long you’d like to have coverage. Plans vary by area, so it’s best to research options on your own. Think Short-Term Health Insurance Is a Good Fit? Learn more about short-term health plans by looking at the top-rated companies and their customer reviews. Learn More
Maybe you just lost your job. Maybe you missed open enrollment. Maybe you just need a health plan to cover a short lapse of coverage. Whatever your situation, a short-term health plan can be a good option if you don't qualify for a Special Enrollment Period or don't want to pay a higher premium. Before you buy a short-term health plan, you need to understand the following: What is short-term health insurance? What does underwriting mean for short-term plans? What laws and regulations govern short-term health insurance? What are the pros and cons of short-term health insurance? How do I get short-term health insurance? What is short-term health insurance? "Short-term health insurance was designed for people who had a gap in coverage. For example, say you accepted a new job but had to wait 60 or 90 days for benefits to kick in. That's when it was a great fit," says Chris Castanes, insurance agent, speaker, and author. These plans typically cover: Doctor’s office visits Some emergency services Some surgery Short-term health plans have many exclusions, which makes them a riskier type of health insurance. “These policies don't cover usually much in the way of preventive care — like wellness visits and annual checkups with your primary care doctor or OBGYN. They also only might provide discounts for some prescriptions, but they won't cover more expensive Tier 3–5 type pharmaceuticals,” says Adam Hyers, Hyers and Associates, Inc. insurance agent. Exclusions also include pre-existing conditions. For example, if you need emergency services for a pre-existing condition, the plan usually won’t cover your care. John Barnes of My Family Life Insurance identifies an even bigger problem: "Generally speaking, if you are diagnosed with a health condition during your coverage, the plan will pay. However, when your benefit term is up and you need re-enroll, chances are the carrier will not cover you or your condition going forward. What will you do then? You have to wait for the ACA open enrollment, which could be months away. You'll potentially be exposed to significant health care costs." Short-term insurance plans usually have cheaper premiums because there are so many exclusions. However, with all the exclusions, short-term health insurance isn't a good fit for everyone. "I usually don't recommend these plans to consumers because of these omissions. However, short-term health plans may be valuable to a pocket of consumers including, but not limited, to: 1. students at colleges/universities2. people on early retirement and waiting for enrollment to Medicare3. immigrants here in the United States who are legally in the process of obtaining green card/permanent residency While it is true that consumers can save money on premiums compared to a similar ACA health insurance plan, consumers need to read the fine print on these plans and be aware of limitations," says Barnes. Even though the coverage is very limited, having some health insurance is usually better than having none at all. “With the coronavirus having a foothold in the United States, these policies might be a good way for the uninsured to find affordable coverage for unknown issues that could result from something like that,” says Hyers. Keep in mind that short-term health plans do not have to offer coronavirus coverage like comprehensive plans. As awareness and concern develops, coronavirus care may be excluded from these policies. Be sure to read your policy carefully to understand the terms before buying coverage. Some states have opened special enrollment periods to allow people to buy comprehensive coverage that will offer coverage for coronavirus treatment. Back to Menu What does underwriting mean for short-term plans? Underwriting is how insurers determine whether or not they’ll insure someone and at what cost. Plans that follow the Affordable Care Act guidelines have rules that make insurers ignore pre-existing conditions when determining premium costs and require that care is covered even if there are pre-existing conditions. Short-term health plans are not considered acceptable health coverage under the ACA because they do not meet these guidelines. short-term plans are underwritten, which affects your plan in two big ways: You may not be accepted. “There are some drawbacks to these plans. First and foremost — not everyone will qualify. short-term health plans are medically underwritten — so some will not be accepted," says Hyers. Pre-existing conditions are excluded. “Unfortunately, most people don't realize that it's underwritten, so pre-existing health conditions can be excluded,” says Castanes. Back to Menu What laws and regulations govern short-term health insurance? Federal rules allow you to have a short-term health plan for up to 364 days with the ability to renew three times. While these federal guidelines are fairly lax, some states have stricter rules around short-term health plans. Most states allow you to have short-term health insurance for more than two months. Some states cap at almost three months. Others allow people to have these plans longer. Eleven states, however, have more restrictions on these kinds of plans — either not allowing them or having such strict rules that insurers do not want to bother with these plans. According to HealthInsurance.org, short-term health insurance is not available in California, Colorado, Connecticut, Hawaii, Maine, New York, New Jersey, New Mexico, Massachusetts, Rhode Island, and Vermont. If you’re in one of these states, a short-term health plan is not an option for you. Back to Menu What are the pros and cons of short-term health insurance? Short-term health plans have several pros and cons. How these trade-offs affect your purchase decision depends on your health and financial situation and what your health coverage options currently are. Pros Cheaper premiums No enrollment period Quick approval and start date Customizable plans Cons Limitations and exclusions Coverage for a short period Potential coverage denial Maximum benefit from insurance Cheaper premiums vs. limitations and exclusions One of the biggest draws of short-term health insurance is that the premiums are much lower than health plans that offer comprehensive coverage. “Lower premiums are one of the biggest advantages to short-term health insurance plans. They can cost half as less than ACA plans if you don't qualify for a tax credit, says Hyers. Short-term health plans also have more limitations and exclusions when it comes to coverage, which is what makes these plans so inexpensive. No enrollment period vs. potential coverage denial Another great advantage of a short-term health plan is that you can buy one at any point in the year, there are no enrollment periods to limit when you can enroll. However, this flexibility doesn’t help you if you are denied coverage through the underwriting process. Quick start date vs. coverage for a set period Short-term health plans can have a fast effective date. Sometimes, you can be covered the day following your enrollment. This quick turnaround is a nice feature of these plans. You can also buy multiple plans at once to have longer coverage. “Plans can be purchased in some states for up to three years at a time with no need for additional medical underwriting. Other states, the limit is six months, however. So, you need to be thinking about what you'll do when the term is up,” advises Hyers. Like Hyers notes, the downside is that these plans only cover care for a limited amount of time. Understand what your state’s rules are about short-term health plans when you enroll so that you can prepare for your next step. You also need to realize that these plans are temporary. When you buy a new one, you're resetting the whole process. Not only does this affect coverage for pre-existing conditions, it also affects your out-of-pocket costs. Barnes gives a good example: "One confusing part I see consumers have is with the benefit period. If you choose a six-month benefit period. That is your term. Deductibles start over again if you reapply at the end of the term. Let's say you have a six-month short-term health insurance plan with a $1,000 deductible. You have surgery. The provider makes the claim with the carrier, and you pay the $1,000 deductible. Your term ends, and you reapply for a new term without problems. Three months later, you are in a new benefit term, and you need another surgery. You will have to pay that deductible all over again." Customizable plans vs. maximum benefit from insurance Most short-term health plans are customizable. You can choose the coverage length, deductible, and in some cases the coinsurance. Choices on the deductible and coinsurance will affect premium rates. Short-term plans usually also have a maximum benefit amount. The maximum benefit is a cap on what the insurance company will pay towards eligible bills. Any additional costs fall on you. These maximum benefits are usually fairly high, like $250,000 or $2,000,000. In addition to how much the maximum benefit is, you should also pay attention to what kind of maximum benefit it is. Is it a lifetime benefit or is it for each plan’s term? If the benefit renews with each plan’s term, that’s ideal. If the plan has a lifetime benefit, once it’s used up the insurer may not pay more even if you renew the plan. Think Short-Term Health Insurance Is a Good Fit? Learn more about short-term health plans by looking at the top-rated companies and their customer reviews. Learn More Back to Menu How do I get short-term health insurance? If short-term health insurance is a good fit for you, you just need to find companies that offer short-term plans. Compare your options from several companies and thoroughly investigate the exclusions. Then, work with the insurance company to enroll in the plan. You can also work with an independent insurance agent to help you through the research and comparison process. If you work with an agent, they can help you enroll in a plan. However you choose to enroll in a short-term plan, be sure to do your research and thoroughly understand the terms, limitations, and exclusions. To learn more about what top companies offer, read part two of this series “Short-term health insurance: What top companies offer.”
We're in the midst of tax filing season. You may be looking forward to a nice tax return or worried about how much you'll owe. If you used a Health Savings Account (HSA) last year, you'll need to have a few more documents on hand as you prepare your taxes. HSAs are paired with High Deductible Health Plans (HDHPs). With these plans you can set aside pre-tax dollars that'll remain tax-free as long as they are used for medical expenses. The funds in your HSA rollover year to year and can be invested for more growth. Here's what you need to know about HSAs when you file taxes this year: Contributions Withdrawals Tax forms Federal vs. state taxes Contributions The IRS sets annual limits on how much you can contribute to your HSA. The limits for 2020 are $3,550 for an individual and $7,100 for a family. Knowing the contribution limits will help you maximize the tax benefits and avoid penalties for over-contributing. Expert tips Contribute up to the annual limit Andrew Latham, certified personal finance counselor and SuperMoney.com managing editor“If you didn't hit your limit and you can afford it, contribute the maximum amount before April 15 and designate them as 2020 payments before you contribute to other tax-advantaged accounts. On the other hand, you don't want to exceed your HSA contributions limit. If you do, you will have to pay a 6 percent excise tax on excess contributions. You can use Form 5329 to work out how much you need to pay in excise tax. However, the good news is if you do mess up, you can withdraw any excess contributions from your HSA and avoid the excise tax as long as you do it by April 15 (or later if you were granted an extension). Just make sure you report the excess contributions and any interest you earned from them as income.” Take advantage of catch-up contributions Robert Lindstrom, CFP ®, Enrolled Agent, Provision Financial Planning“There are two neat tricks people can use with their HSA. First, they can still contribute for 2020 directly reducing their taxable income. Second, a spouse 55 or over can contribute $1,000 as a catch-up contribution to their own HSA separate from the employee’s account as long as they are covered under the plan.” Alistair Bambridge, Bambridge Accountants“Contributions to HSA are before you pay any tax, for 2020 the limit is $3,550 for individual HSAs and $7,100 for families. When you are 50 or older you can contribute another $1,000 per year. Exception is if you are enrolled in Medicare, then no contributions are allowable. Earnings from an HSA are tax exempt which is a big plus. Withdrawals from an HSA are tax free if you use them for qualified medical expenses. If you live in New Jersey or California, you don't get to deduct the contributions on the state return, just the federal.” Plan HSA contributions and enrollment in Medicare John Norce, Medicare Portal president“People with HSA accounts need to know that if they enroll in Medicare Parts A and/or B, they can no longer make contributions to their HSA. If you work at least six months past 65 and apply for Medicare, note that your Part A will start six months prior to your date of submission. Under IRS rules, that leaves you liable to pay six months’ of tax penalties on your HSA. So it is important that you coordinate your funding of an HSA with your enrollment into Medicare A and/or B.” Withdrawals If you used your HSA account last year, you’ll need to document how you used those funds when you file taxes. Since these funds are tax-free because they are for medical expenses, you have to show the IRS you used the funds appropriately. Expert tips Use your HSA wisely David Bakke, DollarSanity tax expert“Health savings accounts come with tax benefits, just be careful so you don't end up paying what could be a variety of penalties and unnecessary taxes. That said, to begin with, money deposited into an HSA is free from taxation, as is any interest you may earn on the account. Just make sure that any withdrawals you make are for qualified medical expenses, because if you don't the money is considered income which is taxable, and there might be an additional 20 percent tax (assuming you are younger than age 65). And finally, there is one other important distinction regarding HSAs and taxes. Any qualified medical expenses which are paid for using funds from your HSA cannot also be claimed under the realm of medical deductions when filing your taxes. You can't double-dip.” John Norce, Medicare Portal president“For those on Medicare, you can use your existing HSA funds to pay for Medicare premiums for Parts B, C, and D as well as copayments and deductibles related to medical and prescription costs. Also, you can use it for vision and dental expenses.” Keep the receipts Andrew Chen, Hack Your Wealth Founder“You should save your receipts for qualifying healthcare purchases, but no one other than the IRS will ask to see them. Your HSA bank will reimburse you for health expenses and will not ask to see your receipts. The IRS may ask for your receipts if you get audited, but otherwise you aren’t required to submit them anywhere.” Tax forms There are several tax forms that you may need when you file taxes. You’ll most likely start with Form 1040 and your W-2. If you’ve been contributing to your HSA before you get your paycheck, those contributions will appear on your W-2. You’ll also need to complete and submit Form 8889. This form summarizes all of your HSA information for the IRS. “When filling out your tax return, you will need to report contributions to your HSA on your 2020 tax return on an IRS Form 8889 –Health Savings Account (HSA), which will be included with your regular tax return. You will report what type of high deductible health plan you participate in (self-only or family coverage), the amount of contributions that you have made to the HSA, any catch-up contributions made if you are age 55 or older, any contributions your employer made on your behalf, and any other HSA contributions made. From this, you will determine the amount of your HSA deduction and include that on your tax return. You will also use IRS Form 8889 to report any distributions from your HSA in 2020. You will list the total amount of HSA distributions for 2020 and the amount of qualified medical expenses that the HSA distributions paid for,” says William Sweetnam, ECFC legislative and technical director. You need to understand that if you used your HSA for medical expenses, you cannot claim those expenses as a tax deduction. The money you used to pay for them was already tax-free. “When it comes to itemizing your medical expenses, your deductible expenses must be more than 10 percent of your adjusted gross income. If you used your HSA to pay for medical expenses, then you can’t itemize for the same expenses. When it comes to filing your tax returns — especially as it relates to your medical deductions — you’ll want to speak with a tax professional who can help make sense of all of the nuances, exceptions, and rules,” says Alexa Serrano, Finder.com banking and investments editor. According to Lively, you’ll receive Form 5498-SA (HSA contributions) and Form 1099-SA (HSA distributions) from your HSA custodian by the end of May. You may want to request an extension for filing your taxes because of this delay. Keep in mind that extensions are only for filing, not paying your taxes. If you’ve exceeded the HSA contribution limits for the year, you’ll also need to complete Form 5329. Federal vs. state taxes HSAs have nice tax benefits. However, these tax benefits may be different for state and federal taxes depending on where you live. Your taxable income is adjusted for federal taxes based on the contributions you make to your HSA throughout the year. Many states that have an income tax also offer an adjustment for HSA contributions. “While you can always get a tax deduction for HSA contributions at the federal level, you can only sometimes get a tax deduction at the FICA and state level. You’ll only get the 7.65 percent FICA tax deduction (a unique feature of HSA contributions) if you contribute through employer payroll deductions,” says Chen. California and New Jersey tax HSA contributions. New Hampshire and Tennessee tax HSA earnings, not contributions.
Updated September 10, 2021. Guest Post by Elissa Suh Open Enrollment for health insurance is soon to be underway — the federal open enrollment is from November 1 to December 15, 2021. However, more than 88 percent of Americans could not correctly identify these dates, according to the third annual Policygenius Health Insurance Literacy Survey. The survey also found that many people — more than one in four — avoided getting treatment because they didn’t understand their health insurance coverage. Health insurance can be daunting and challenging to navigate, but starting with the basics is a good place to help you prepare to make the best choices for your health and finances. Survey respondents also had trouble with basic health insurance terms like copay, deductible, and premium. Fewer than a third of people correctly defined all three terms. To help you get ready to choose your health insurance plan for 2021, here are seven terms to know: Premium Copay Deductible Coinsurance Out-of-pocket maximum Essential health benefits Short term plans 1. Premium A premium is the amount you pay for health insurance every month, whether you pay it directly or it’s automatically deducted from your paycheck if you have insurance through your employer. It’s the first cost you encounter when you have health insurance, and yet only a little over half (55.9 percent) of survey respondents could correctly identify the term. There are five plan categories — Bronze, Silver, Gold, Platinum, and Catastrophic — and each has a different way you and your insurer share costs for your care. You will have to pay a higher premium for Platinum plans, but will pay less out of pocket before insurance starts to cover the bills, or you can opt for a Bronze plan, which means you’ll have lower premiums but pay more out of pocket before insurance starts to cover medical bills. 2. Copay Copay, short for copayment, is a fixed amount you pay for a covered medical expense. Your copay amount will vary, based on your health plan and the type of service you receive (like a specialist physician, primary care physician, urgent care visit). Generally, copays are around $30 and do not count toward your deductible. Out of the health care terms asked about in the survey, “copay” caused the greatest confusion — only 40 percent of people could define it. 3. Deductible A deductible — the amount of money you pay out of pocket before insurance coverage kicks in — was a term that approximately half (49.6 percent) of survey respondents could correctly identify. For example, if your plan has a $1,000 deductible and you need to undergo a $3,000 surgery, you would have to pay $1,000 on your own, before the insurance company could start helping with the costs. And, because you’ve met the deductible, the next time you have a covered medical expense in the calendar year, insurance will pick up the bill in its entirety. Knowing how the health insurance deductible works can help you understand other types of insurance, too, like homeowners or auto insurance, as the concept remains the same. 4. Coinsurance Coinsurance is the percentage of health care costs you have to pay after you’ve met your deductible (until you meet your out-of-pocket maximum). Coinsurance is represented as a percentage or split, like 20 percent or 80/20. This means you pay for 20 percent of the costs for a covered medical expense, and the insurance company pays for the remaining 80 percent. 5. Out-of-pocket maximum The out-of-pocket maximum is the most you’ll have to pay for covered health care services in a given year. After you spend enough money on medical expenses to reach the out-of-pocket maximum, your insurance provider will cover 100 percent of your care. The out-of-pocket maximum limit depends on your health plan and resets annually. The government also sets an overall limit: For 2021 plans, the limits are $8,550 for individuals and $17,100 for families. 6. Essential health benefits Did you know that under the Affordable Care Act, all health insurance plans are required to cover the same 10 essential health benefits? The 2019 Policygenius survey asked about these benefits and found that nearly 87 percent of people didn't know what services were required. The 10 essential health benefits are ambulatory services (outpatient care), emergency services, hospitalization (inpatient care), laboratory services, mental health coverage, pregnancy/maternity/newborn care, rehabilitative services, pediatric care, prescription drugs, and preventative care. 7. Short-term health plan Short-term health plans were established as a way to help fill temporary gaps in insurance coverage, not to act as a comprehensive health plan. They’re not substitutes for traditional health insurance plans and do not have to adhere to standards in place by the Affordable Care Act, so they aren’t required to offer any of the essential health benefits mentioned above. This type of health insurance may cost less than a marketplace plan, but it also includes less coverage. Short-term plans are increasing in popularity, but not many people know how they work. According to the Policygenius survey, only 9.9 percent of people knew how long a short term plan could last — they’re typically limited to under a year, but can be renewed for up to a total of 36 months. Elissa Suh is a personal finance and insurance expert at Policygenius in New York City. She has previously worked in television research and written about film for IndieWire, MUBI, and Paste Magazine.
Health insurance is an important way to get the health care you need while protecting your finances from large medical costs. It's also important to find a health plan that fits into your budget from a trustworthy insurer. However, not all health plans are equally beneficial. So, how do you know if you have a good plan? There are four essential things to look at when evaluating your health insurance options: Coverage Health services costs Prescription costs Premiums Analyzing these four aspects will help you understand how good your health plan is and its overall affordability. Coverage The most essential part of your health plan is what it covers. If there are medical services or prescriptions that you know you will need, check to make sure that the health plans you’re looking at covers those. Health insurance plans on the Health Insurance Marketplace (on-exchange plans) cover the Essential Benefits outlined in the Affordable Care Act. Off-exchange plans offered by private insurers also meet these guidelines. Essential benefits include preventive care services like your annual physical, certain prescriptions and vaccinations, and care for pregnant women, children, and infants. Plans that are not compliant with the Affordable Care Act may not cover all of the essential health benefits. These include short term health plans and indemnity plans. It’s especially important to carefully review the coverage on these plans before choosing one. Some plans may also cover medical devices like crutches and blood sugar monitors. Coverage rules can vary by plan, so check your plan to learn more about what's covered. Coverage also goes beyond covered services and medical devices. It includes the network of doctors and specialists included with your health plan. If you already have doctors that you like or prescriptions you require, it’s worth checking to make sure they would be covered under any new plan you’d choose. When it comes to networks, some plans only offer in-network coverage. Other plans offer in- and out-of-network coverage, though the cost-sharing rules may put a higher burden on policyholders for out-of-network services. Emergency services are always covered, regardless of where they were received. Keep in mind that health insurance companies have negotiated discounted rates with in-network providers, which makes visiting those providers cheaper for them. Since they do not have discounted rates from out-of-network providers, it's more expensive for the company when you receive out-of-network care. The company passes some of this expense on to you by charging higher rates in these cases. Questions to ask yourself What health services do my family and I need? Are there procedures or surgeries that my family and I will need in the next year? What medications, medical devices, and prescriptions do my family and I need? Know the answers to these questions before shopping for health insurance. This will help you quickly eliminate plans that won’t meet your health needs. Health services costs Many people assume that the monthly premiums reflect the full cost of the insurance plan. While premiums are the most frequently occurring cost for a health plan, the full cost also includes the cost-sharing burden on the policyholder. Each health insurance plan has its own cost-sharing rules, so be sure to look at how much the health insurance plan covers for different medical services. This will be listed in your plan’s Schedule of Benefits. Depending on your plan’s cost-sharing rules, you may be responsible for a portion of the cost of the medical services you receive. This is in addition to the monthly premiums. Fortunately, there are annual caps on how much you’ll have to pay for cost-sharing expenses. These are called the deductible and out-of-pocket limits. The deductible is the amount you must pay for your health expenses yourself before the insurance company will start paying some of the costs. Don’t worry — many health plans cover preventive services fully, at no cost to you. Health insurance also gives you access to discounted, negotiated rates from health care providers in your plan’s network. These discounted rates are advantageous, even when additional coverage and cost-sharing is delayed. The out-of-pocket maximum is the total amount you’d have to pay for health care costs for the year. Once it’s met, your insurance company will pay fully for covered services, other than your monthly premium. The deductible is often lower than the out-of-pocket max for this reason. Copays and coinsurance count towards your deductible and out-of-pocket maximum. Look at how high the deductible and out-of-pocket limits are for each health plan you consider. Compare the deductible and out-of-pocket limits across plans. It can also be useful to look at differences in copays and coinsurance. Copays are a set amount that you pay when you receive medical services. Coinsurance is a set percentage of the cost of services that the policyholder is responsible for. Coinsurance can be trickier to estimate because it depends on the negotiated price the insurance company has with the doctor. Questions to ask yourself What would the health services my family and I need cost under each health plan? (General information about these costs is available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Which plan has the best cost-sharing for specialist visits and urgent care clinics? Which plan has the best overall cost-sharing for the health services my family and I need? Prescription costs The cost sharing methods for prescriptions varies based on what tier the prescription falls under. Depending on the plan, you’ll either pay copays or coinsurance on prescriptions. Some health insurance plans may have different deductibles and out-of-pocket limits for medications than for other health services. Once these are met, the insurance kicks in at a higher level. Questions to ask yourself What tiers are my family’s and my prescriptions in? What would the regular prescriptions that my family and I need cost? (General information about these costs is also available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Premiums While the monthly premiums do not reflect the full cost of a health plan, they still contribute to the total cost of the plan and you need to make sure that they fit into your monthly budget. Look at a few health plans to get a better sense of what current premium rates are in your area. You can also check to see if you qualify for a government subsidy that can make premiums for an on-exchange plan more affordable for you. Questions to ask yourself What is the most I want to spend on health care next year? (Take the overall cost into account.) What is the most I can comfortably spend on premiums? What would I ideally spend on premiums? Answering these questions will help you narrow down your options further and choose the most affordable plan for your situation. Affordable health care Fully evaluating your health insurance plan before enrolling will help you make an informed decision. Understanding the details of each health plan will help you find one that covers the medical services you need. Looking at the deductible, out-of-pocket max, and cost-sharing amounts will give you a sense of what you’ll spend on medical care and medications in addition to the monthly premium. Working with the insurance company to get pricing on what different medical services and prescriptions would cost with a certain policy will help you understand the total cost of the plan in more detail. Analyzing your budget, premium rates, cost-sharing expenses, and coverage are key to finding affordable health care. Oscar Health Insurance and "GAUZE: Unraveling Global Healthcare" executive producer and director Suzanne Garber consulted on this article. Need more health insurance enrollment tips? 4 Ways to Prepare for Open Enrollment Pitfalls to Avoid During Open Enrollment 5 Questions to Ask About Special Enrollment Periods
Updated January, 2020. In general, people can only enroll in a health insurance plan during Open Enrollment. Medicare also has its own Annual Enrollment Period and its Initial Enrollment Period varies depending on your birth date. However there are some exceptions, including Medicaid, CHIP, and qualifying for a Special Enrollment Period (SEP). If you qualify for a Special Enrollment Period, you have a certain amount of time to make changes to your health insurance plan or enroll in a new one to ensure that you maintain the health insurance coverage you need. Here are some of the most common questions regarding Special Enrollment Periods (SEPs): What is a Special Enrollment Period? What qualifies as a Special Enrollment Period? What are my health insurance options? How do I apply for a Special Enrollment Period? What is a Special Enrollment Period for Medicare? What is a Special Enrollment Period? Special Enrollment Periods (SEPs) let you make adjustments to your health insurance coverage or enroll in a new plan outside of Open Enrollment under certain circumstances. These circumstances are referred to as a Qualifying Life Event. Having missed Open Enrollment does not make you eligible to apply for a Special Enrollment Period. Special Enrollment Periods typically last 30-60 days, which allows plenty of time for you to look at your health coverage options and make the necessary insurance coverage adjustments. “Don't forget about deadlines, and keep in mind that they're different for employer-sponsored plans versus individual market plans. For employer-sponsored plans, you'll generally have 30 days, whereas in the individual market, you'll have 60 days (some qualifying events trigger a special enrollment period both before and after the event, whereas others are only after it),” says Louise Norris, licensed agent and author of Insider’s Guide to Obamacare’s Special Enrollment. Whether you receive health insurance from your employer or purchase your own separately, you may qualify for a Special Enrollment Period as your life changes. If you purchase health insurance independently, you can work with an insurance agent or use online tools that make it easy to explore all your options before you make a change. “Never buy from an agent who only has one product. You need someone who can shop around effectively and give you options. Never call the health insurance marketplace on your own without guidance from an agent. The customer service reps are not agents, and you may not understand the rules and regulations they have,” Maria Townsend, Insurance Advisor, says. HealthCare.gov shows all of the group health insurance plans created by the Affordable Care Act. After you complete a questionnaire, it will include any subsidies you qualify for in the listed premium quotes. If you don’t want to buy a Marketplace plan, you can view covered benefits and costs (monthly premiums, deductibles, out-of-pocket expenses, etc.) offered by multiple companies by looking at a comparison website. A few health insurance comparison websites are HealthMarkets, HealthCare.com, and GoHealth.It’s a good idea to be careful when shopping online. Some websites are designed to generate leads for health insurance providers and sell customer information to multiple insurance companies, instead of just connecting the customer to the company and plan they requested. If you can’t see price estimates and plan details before providing contact information, it may not be the best resource.Townsend says, “I would stay away from the insurance sites that sell off your info for a price comparison, and later get 100 calls from different reps. Those sites never check your medications or doctor network to even know if it's a plan that meets your needs personally. I recommend sites like FreeInsuranceGuru.com, where you can chat, call, or even video chat with an agent licensed in your area and your information isn't sold.” Back to Menu What qualifies as a Special Enrollment Period? A Special Enrollment Period occurs when you experience a Qualifying Life Event. These events are life changes like Losing current health insurance Moving Getting married Having a baby or adopting Income changes Gaining Tribe membership Gaining U.S. citizenship Release from prison Starting or ending Americorps service You can also qualify for a Special Enrollment Period if the company you enrolled with made an error in the information they provided or breached their Marketplace contract. If you experience a qualifying event, you can make changes to your insurance coverage, like adding people to your current health plan. Keep in mind that even if you have a Qualifying Life Event, other rules still govern Special Enrollment Periods.Norris says, “In the individual market, keep in mind that most special enrollment periods now require that you had coverage prior to the qualifying event, so they serve as an option to change coverage rather than go from being uninsured to having coverage. So while getting married or moving to a new area used to allow a person to gain coverage after being uninsured, that's no longer the case (for marriage, at least one spouse must have had coverage prior to the marriage, although the other could have been uninsured). Some individual market rules limit enrollees' ability to use special enrollment periods to upgrade their coverage during the year. All of this is opposed to open enrollment in the fall, when anyone can sign up or change their coverage, regardless of their prior insurance status.” Back to Menu What are my health insurance options? For the most part, Special Enrollment Periods allow people to add a person to their current plan or enroll in a new plan. If you’re enrolling in a new plan, you can enroll in An employer-sponsored plan A Marketplace plan A private insurance plan Research to learn the health insurance plans available to you and what they cost. If you’re losing insurance coverage because you left a job and are starting a new one, it’s a good idea to enroll in some kind of health insurance plan. Most employers have a waiting period before new employees can enroll in health insurance. To ensure that you have coverage during the waiting period, you can buy temporary health insurance, enroll in a Marketplace plan, be added to your spouse’s employer plan, or extend your employer’s health insurance coverage using COBRA.“Nobody needs a qualifying event to enroll in a short-term plan, as they're available year-round but with medical underwriting. However, it's also common to see short-term plans being marketed to people who are aging off their parents' health plan or losing access to an employer-sponsored plan when they quit their job. In both cases, the person is actually eligible for a SEP in the individual market (where there's no medical underwriting, pre-existing conditions are covered, and the plans include essential health benefits coverage), but people sometimes enroll in short-term plans because they aren't sure what other options they have,” Norris says.Short-term health insurance plans are an option that’s always available. They can be a good choice, but don’t offer the complete coverage that standard health insurance plans offer.If your spouse has insurance through their employer, you can also be added to their plan. “The qualifying event that triggers COBRA eligibility (and the SEP in the individual market) will also trigger a SEP that would allow the person to join their spouse on the spouse's employer-sponsored health plan (assuming the spouse has such coverage and the plan offers spousal coverage). But as noted above, that SEP only has to last 30 days, whereas it's 60 days in the individual market and there's a 60-day window for COBRA,” Norris says. What is COBRA Insurance? COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It is the legislation that allows former employees to continue health insurance coverage from their former employer for a certain amount of time until they find new coverage up to 18 months. Individuals who use COBRA coverage must pay the employer’s contribution and an administrative fee in addition to the monthly premiums. Norris says, “If you're being offered COBRA, take your time to compare individual market plans and COBRA — you don't want to jump into either option without understanding all the details, but you've got 60 days to make your decision.” When choosing between enrolling in a new plan or COBRA, research your options. Townsend suggests, “Reach out to an experienced insurance agent, who can provide you many options and speak to you intelligently about what options they have for you verses the COBRA route. Go online and shop if you enjoy shopping online!”Evaluating the costs and benefits of using COBRA versus another health insurance plan will help you make the best decision for your circumstances. The nice thing about using COBRA is that the coverage can be retroactive if you enroll later during your Special Enrollment Period.Norris offers a few scenarios in which COBRA may be ideal: “You're in the middle of a complicated course of treatment and don't want to have to worry about switching providers, dealing with a new drug formulary, etc. So a person going through cancer treatment, for example, might be better off with COBRA than with switching to the individual market. You've already met or nearly met your out-of-pocket maximum for the year. If you switch to a new plan in the individual market — even if it's from the same insurer that offers your group benefits — you'll have to start over with your out-of-pocket expenses. Your income is too high for premium subsidies and you're fairly certain you're going to have access to a new employer-sponsored plan soon. In that case, keeping COBRA will be less complicated than having to enroll in a new plan only to switch away from it again in the near future when you switch to the new employer-sponsored plan.” However, there are a few reasons why enrolling in a new plan might be better. “An individual market plan might be much less expensive, especially if you qualify for premium subsidies and/or pick a plan with higher out-of-pocket exposure than the one you had through your employer. Premium subsidies are available this year to a family of four with MAGI as high as $100,400, whereas there's no financial assistance available to offset the cost of COBRA. Depending on the specifics of the plan you had through your employer and the options that are available in the individual market in your area, you might find that you can pick an individual market plan that has a provider network and/or drug formulary that work better for you,” says Norris. If you’re eligible for COBRA and Medicare, you might want to enroll in both or opt for Medicare. “One serious mistake I see people make with COBRA is when they are also eligible for Medicare. They elect COBRA, but do not enroll in Medicare Part B. Medicare says you need to enroll in Part B even when electing COBRA and over age 65. Failing to do so can cause a lifetime Part B premium penalty because of a late enrollment fee,” advises Adam Hyers, owner of Hyers & Associates Insurance Agency. How do I sign up for COBRA? Employers are required to offer information on COBRA and enrolling in COBRA to their employees. Your employer’s human resources department can answer your questions and help you access coverage through COBRA. Back to Menu How do I apply for a Special Enrollment Period? For the most part, it’s not a matter of applying for a Special Enrollment Period, it’s a matter of enrolling in a health insurance plan or making adjustments to your coverage.If you have a qualifying life event, talk to your employer’s human resources department. The human resources team will help you through the process--whether you are enrolling in a different plan, making adjustments to add coverage, or using COBRA.If you don’t have insurance through your employer, contact your health insurance company. They will tell you what documentation they need and help you with the changes you need to make.If you’re choosing a new health insurance plan, research your options online. You can view your options by looking directly at company websites, looking at comparison websites, or looking at Marketplace plans on HealthCare.gov. Representatives from these websites can also help with the enrollment process.Getting advice from a licensed independent agent is always a good idea, especially if you’re working directly with a company. “I always stress the importance of sitting down with a licensed, non-biased insurance agent who can provide information on coverage and price on various policies from an array of carriers so you can find the policy that best meets your needs and budget. Whether you are enrolling in ACA or COBRA, understanding what is and is not covered and what the cost will be to you (and your family, if applicable) is very important,” says Chris Mason, Senior Vice President of Sales Distribution for HealthMarkets. If you are required to give documentation to show that you qualify for a Special Enrollment Period, do not send the originals. Make copies to send in and keep the originals for you records. Back to Menu What is a Special Enrollment Period for Medicare? Medicare Special Enrollment Periods are slightly different from regular Special Enrollment Periods, although the concept is the same. There are a few more situations that allow for a Special Enrollment Period. The length of the Special Enrollment Period also varied based on the circumstance that triggers it. Start dates also vary.Many of the Qualifying Life Events that trigger a Special Enrollment Period also trigger a Medicare Special Enrollment Period. However, some circumstances are distinct to Medicare.For example, you qualify for a Medicare Special Enrollment Period if you have an opportunity to purchase other non-Medicare coverage or if your current Medicare plan changes its Medicare contract. More information regarding Qualifying Life Events and corresponding Special Enrollment Period details, can be viewed on Medicare.gov.Understanding how Special Enrollment Periods work will help you be prepared, use the time offered to understand your options, and make sure that you have the coverage you need. For more information on Special Enrollment Periods, check out Health Insurance Marketplace’s Guide. Back to Menu