Individual Insurance FAQ's

To protect rates is the simple answer.  At one time, there was a mandate to have coverage.  The more people who participate spreads the risk in the pool of insureds.  If people are allowed to join anytime, there would be no incentive to have coverage prior to getting ill, this would destroy the risk pool.  Only being able to enroll during a limited time frame protects the pool by creating incentive for people to have coverage before getting ill.  Getting sick or hurt is NOT a qualifying event.

A major life change, like getting married, birth, adoption, divorce, or job loss that causes loss of employer coverage to name just a few.  Any of these events may trigger a Special Enrollment Period (SEP) that allows you to enroll in or change your health plan outside of annual Open Enrollment Period.

There is a lot to consider. You should consider the carrier and the provider network that comes with the plan. Consider medication coverage; be certain they are covered. Consider deductibles, max out of pocket limits, and co-pays that fit your needs. Consider the premium that will fit your budget.

You have several options. If you have employer coverage offered to you, you must enroll within 30-days of your loss. If employer coverage isn’t an option or is unaffordable, you have 60 days to get enrolled in the Marketplace or directly with a carrier. This is only a qualifying event if you are losing coverage from your parents’ plan. Otherwise, turning 26 in-and-of itself is not a qualifying event (SEP). Medicaid could be an option if you meet income requirements.

You are no longer eligible for subsidies when you become Medicare eligible.  Some ACA plans will not allow enrollment to individuals over 65.

Yes, you can cancel anytime. If you are enrolled directly with a carrier, they have a form that is required for termination.  If you are enrolled through the Marketplace, you, or (with the assistance of your agent), can terminate.  Changes are made through Marketplace by accounts or by phone.  The Marketplace number is 800-318-2596.  The carrier cannot terminate a Marketplace plan by request.

If you are NOT receiving subsidies – yourself, spouse or any dependent.  To be eligible to receive subsidies, dependents must be claimed on your tax return.

Your Agent and trusted advisor can help you decide.  If there is no chance that your household will qualify for subsidy, we can help you enroll directly with a carrier.  We do like to use the Marketplace for backside protection against the “big – what if” in case your income is greatly reduced because of an unexpected career change, or sickness or injury.  The Marketplace would allow you to adjust your income in times of hardship and possibly reduce premiums in a time of great need. You don’t have the same opportunity or flexibility when you enroll with a carrier directly.