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Medicare for all is the ultimate solution for national healthcare like NHS in the UK. The ability to pay your taxes and not be charged out the wazoo for health insurance premiums.
In fact, I just learned through a search that Elizabeth Warren has a different idea that isn't Medicare for all.
Everything is going to be up to how the legislation is created, and, as we've seen in this country, we don't always get the final result we were promised.
Hi, so the problem is that you can't just enroll in a plan at any time. Open enrollment has already passed. The only way to change a plan is to qualify for a special enrollment period
Quite frankly, if it's that important, the easiest thing is to move. If you live close to a county line, move just over the border. That will give you a special enrollment period.
this is a helpful screener about what exemptions you might qualify for. There’s not one for unemployment, but might be one for your income being low enough...
What you're looking for would be called a catastrophic health plan. For it to count as being insured under the ACA you have to be under 30 years old or have a financial exemption.
If you aren't either, you can probably just contact the insurance company or check their website to apply directly, but you'll probably have to pay the penalty then.
Like Zebra said, your deductible applies to everything, until youve paid a total of whatever your deductible is.
The prices for the meds you are taking might be very different at different pharmacies, so you should shop around. For instance, a membership to a warehouse store like Costco might pay for itself in one month, just in terms of prescription savings. Or not. Youd be amazed at the price differences between the big chains, who youd think would all be paying more or less the same prices. Heres a pretty recent survey from Consumer Reports, they found the same handful of drugs cost anywhere from less than $100 to close to $900 a month, depending on the pharmacy, or even whatever location of that pharmacy. http://www.consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices/
The you listed from healthcare.gov sounds pretty typical in terms of price. For now, and hopefully for a long time, you are going to be one of the people who pays their premium every month and hardly ever uses their insurance. But if you need it, you will be glad you had it, theres a good chance it will "pay for itself" in a very short time.
Heres a general article about types of insurance http://www.agencyinfo.net/iv/medical/types/indemnity-managed.htm
Here is an article you might like, from the consumers union. Its a few years old, but talks about some of plans like US Health Group http://www.consumerreports.org/cro/magazine/2012/03/junk-health-insurance/index.htm
hopefully this is a good jumping off point.
you are correct with one slight caveat. Your friend is probably trying to buy insurance outside of the open enrollment period. It has nothing to do with money. (though she might be trying to spin this as "us against them", because the very very poor can get medicaid at anytime, there is no special open enrollment period for those particular people)
Basically, insurers have to open their doors to all comers (more or less), once a year, and they have the rest of the year to do other things. Your friend apparently didnt have insurance for whatever reason, and decided now, to get coverage because she is pregnant, so essentially shes trying to game the system. (which is a whole nother set of issues). But.. she doesnt want to wait till open enrollemnt in Nov/Dec. So yes, she is correct that she cant get insurance on the exchange right now, unless she qualifies for a special exemption aka SEP https://www.healthcare.gov/glossary/special-enrollment-period/
Age: Premiums can be up to 3 times higher for older people than for younger ones.
https://www.healthcare.gov/how-plans-set-your-premiums/
In most states, the base rate for a plan is calculated using a 21 year old policyholder in mind. This rate is then adjusted according to the age of the consumer. States using the federal age and premium guidelines will see anyone under the age of 21 all treated equally, with monthly costs coming out to a little more than 63% of the base rate for a 21 year old. Health Insurance rates go up as a policyholder gets older, with the largest increases coming after age 50. This reflects the higher expcted share of health care costs that older Americans are expected to utilize.
t the high end of the age range, those consumers 64 and older have their premiums capped at 3 times the premiums of the 21 year old base rate. As you can see from the data, the largest changes in health insusrance costs take place between the ages of 50-60, where premiums go from 1.78x the 21 year old rate to 3x by age 64.
https://www.valuepenguin.com/how-age-affects-health-insurance-costs
So yes, it would appear so.
Health insurance is based on age, location, and income.
>the people at PA COMPASS told her that they have to go through the application process, and if she qualifies for Medicaid she can either take it, or take the Silver Marketplace plan without a subsidy ($250 per month). Is this accurate?
But she may have options via Medicaid coverage that are a) even more affordable and b) provide more flexibility regarding doctors/facilities. Depends on where you are; choices vary from place to place. So, it's worth it to apply.
Or you could look into enrolling your girlfriend as your unmarried domestic partner. From Healthcare.gov's site:
Include an unmarried domestic partner only if you have a child together or you’ll claim your partner as a tax dependent.
Whether you can do this depends on what state you live in.
Or, you could marry the lady, and make her 'respectable' - and by that I mean eligible to be added as a dependent spouse.
So, options! Isn't adult life fun?
You don't owe the fine. There is no fine for people living in states that haven't expanded Medicaid that are below 100% FPL. https://www.healthcare.gov/exemptions-tool/#/results/2015/details/secretary-hardship
I don't see how that much could be allocated to the dependent. The APTC is based the second lowest cost silver plan (SLCSP) in the area. If you're separating the tax households you'll have to recalculate the SLCSP for each household. The one on the joint 1095-A they were issued is now incorrect. I don't think there's an area out there that approaches $10k for the dependent's coverage alone so this is likely closer to $4k in APTC that can be allocated(guessing). See pages 12-13 of the form you linked and check out this tool here
So there's still an advantage to doing this, but not as much they're trying to claim. That's just my interpretation of the situation, I'll be interested in what others have to say.
You can earn up to $98,400 and still qualify for tax credits on the Marketplace with a family of 4 (source. Cover kids will be cheaper but you’ll have to earn so much less... you won’t come out ahead by earning less, as long as you stay below that $98k mark. Since you’re self-employed, you’ll report only your net income (Modified AGI) for the Marketplace - you can take lots of deductions, including for health insurance. Go here to preview plans. And yes, you have 60 days after your children’s birth to enroll. Congrats!
Healthcare.gov has a good explanation of what qualifying life events entail. https://www.healthcare.gov/glossary/qualifying-life-event/
As for the coverage, I believe employers only have to cover 50% of the cost based on the cheapest plan they offer. It varies from state to state, but that's what I've read. If he's meeting that then you're out of luck unfortunately.
Insurance has gotten crazy expensive the last two years, in my own scenario my insurance went up more than my raise, so I'm making less than I did two years ago after everything is said and done. I can't totally blame your boss for cutting back. Might be time to look for a new job, but it'll be hard to find one that offered that sweet of a deal.
read your member benefits manual, your SBC (summary of benefits), and keep track of your claims and EOBs. Youll be light years ahead. And read this. https://www.healthcare.gov/coverage/preventive-care-benefits/
Its not a hack, it just being an educated consumer, which is actually a huge amount of work.
Have you looked on www.Healthcare.gov? Based on your income, you should be eligible for subsidies that reduce the cost of insurance.
Fill out this page:
https://www.healthcare.gov/see-plans/
and you will see approximately how much subsidy you are eligible for, and what plans are available.
If you expect to make under $24,120 in 2018, you will be eligible for especially good subsidies that reduce your deductible substantially (but only if you buy a silver plan!). Even if you make a little bit more money than that, I would just try to estimate your income as being under $24,120 because these extra subsidies (called "cost sharing reductions") do not need to be paid back, no matter what, and they give you a way better deal.
I would not mess with those healthcare sharing ministries. These ministries are not technically legally obligated to pay for your healthcare, so there is no guarantee that they will pay when you really need them to. On the other hand, regular health insurance companies are definitely legally obligated to pay for valid healthcare claims.
Also, your income is low enough that you can probably get a pretty decent deal on health insurance, compared to the cost of a health care sharing ministry.
Also keep in mind that since your employer is offering a plan, you won't qualify for the premium tax credits on the exchange.
The below is taken from this link: https://www.healthcare.gov/have-job-based-coverage/options/
If you have job-based coverage, you might be able to change to a Marketplace plan. But you probably won’t qualify for a premium tax credit or other savings. As long as the job-based plan is considered affordable and meets minimum standards, you won’t qualify for savings. Most job-based plans meet these standards.
First off, you don't pay insurance agents. They are paid by the insurance companies. They are free to use. Second off, as long as your husband is here legally, receiving an ACA subsidy is not a public charge and should have no impact on any affidavit of support (AOS) rules that go along with visa applications. https://www.healthcare.gov/help/immigration-status-questions/
"If you check the box showing you have eligible immigration status, we’ll use information from your application only to determine eligibility for health coverage through the Marketplace. This is true whether or not you’re applying for help paying for your Marketplace coverage. Use of health services through the Marketplace won’t be considered to be a public charge."
As the other poster said Health Savings Accounts are only available to individuals with a High Deductible Health Plan. You can try seeing if your employer offers a Flexible Spending Account - Which is similar in that it allows you to deposit pre-tax money to pay for medical expenses. You can find more information in the link below.
https://www.healthcare.gov/have-job-based-coverage/flexible-spending-accounts/
Here's a link to the healthcare.gov page that talks about what income to include.
https://www.healthcare.gov/income-and-household-information/how-to-report/
"Marketplace savings are based on your expected household income for the year you want coverage, not last year’s income."
They use computers to keep track of each plan profile and how the bills are calculated.
There is a small carve out of services that are covered, regardless of deductible, under current law (the ACA) but this may change if the law changes. Remember that going to the Dr to receive these services , may still result in a bill for you, since the Dr will probably do other things at the same visit. https://www.healthcare.gov/preventive-care-adults/
If the individual plans offer any additional carve outs (services that are charged differently than the normal deductible/co-pay structure), that will be noted in your plan documents.
I basically agree with NYIIP and blackout, but dig out your Summary of Benefits and Coverage (SBC). The 8-10 page document looks like this. It may give you what you need to get clear on this.
Yeah, all health coverage is "local" - highly dependent on your specific circumstances. Post the name of the insurer, or a picture of your de-identified member ID card, or even better - a link to your Summary of Benefits and Coverage (SBC). It looks like this. Plans are obliged to make this 8-10 page "nutrition label for health coverage" available to you. call the service # on your ID card to get a copy if it's not available at whatever kind of website they maintain for members.
How about you go first? Post a de-identified picture of a document from your family's health coverage: an ID card, a Summary of Benefits and Coverage (it looks like this), some kind of document with your plan's name & other background info on it
Firstly, I'm really glad that you're doing so well.
I looked at it, and Sloan Kettering isn't in network for any exchange products at all. The NY Times actually wrote an article about it.
https://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html
There are no plans that you can purchase individually that will get you access to Sloan. You are going to have to change providers. When you first enroll with insurance, you will be able to get them to continue paying for visits to Sloan for about 60 days or so. It's called "continuity of care". However, the point of that is that they have to transition you off of sloan and into an in-network provider. Sloan will not be able to get your carrier to allow you to see them indefinitely.
Unfortunately you more than likely have to update your marketplace insurance.
Check this page:
https://www.healthcare.gov/have-job-based-coverage/
You don't have to take the new insurance, but since you're offered a qualifying health insurance plan through your employer, you lose entitlement to the subsidies.
Yes it does.
>You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if:
>>You leave a job where you had health coverage (even if you left your job by choice or were fired).
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.
Percentage of income:
2.5% of household income Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace
Per person:
$695 per adult $347.50 per child under 18 Maximum: $2,085
To qualify for a catastrophic plan, you must be under 30 years old OR get a "hardship exemption" because the Marketplace determined that you’re unable to afford health coverage.
You can find the list of hardship exemptions here:
https://www.healthcare.gov/health-coverage-exemptions/hardship-exemptions/
Every state/region is slightly different but here are the basics. The Obamacare exchanges are going to have all of the major insurance carriers available in your area for individual insurance. $200 a month is not an unreasonable amount for an individual health plan. $30 a month, I can assure is not real insurance with a reputable carrier, and a network of hospitals and physicians. Most likely you are looking at a MEC plan which stands for minimum essential coverage. Basically it's a type of indemnity plan that offers some dollars towards medical events but is not real insurance. Here is a better definition of a MEC plan.
https://www.healthcare.gov/glossary/minimum-essential-coverage/
>Do I have to file an exemption if I use an out-of-Marketplace health cost sharing ministry?
No, god will let the IRS know for you.
....
Yes, of COURSE you have to file an exemption.
Geez, I thought young people were good at this internet stuff.
But please promise not to get seriously ill or injured while you have this ministry business. Because you might undergo a 'conversion experience' of a sort you never expected....
>Say I see my PCP tomorrow, so before 1 cent was counted towards my deductible...Do I pay the full cost of that doctor visit or the $30 co-pay?
Depends. You seeing your PCP for preventive treatment/exam? You may not even pay your copay. Is the visit for treatment for some malady? Pay the full cost of the bill until you reach your deductible - maybe.
We'd need the specs for your plan to be sure. Your Summary of Benefits and Coverage (SBC) would tell us. [It looks like this](http://www.consumerreports.org/health/resources/pdf/SBCinfo.pdf. Get us a link to that.
>...general nursing care, hospital services, supplies and outpatient services are all 80% covered after deductible.
Can someone explain what that means?
it means that after you have met your plan's deductible for those services, you pay 20% of any remaining covered charges for those services.
You Summary of Benefits and Coverage (SBC) provides more information about your plan's benefits design and coverage of those services. Your SBC looks like this. If you don't have the copy your insurer or your employer sent you, contact them to ask for a link to one (they're usually provided as PDFs). The last page or so of your SBC also explicitly includes an example of your plan's coverage of a normal, or routine, childbirth - they may have done the explanatory work for you!
As you're discovering, this is not a pharmacy issue, or an insurer issue, but an issue of the drug formulary your husband's employer's plan is making use of for Rx coverage.
if you can, try to post a link to your husband's plan's Summary of Benefits and Coverage (SBC). It looks like this, right down to the color scheme. All plans are required to supply plan participants with these "nutrition facts labels" for health coverage, which provide a standardized summary of plan features, and include links to things like plan drug formularies. With that we can zoom in on the issue you're having and "see" - or not - what you're seeing.
>This is the type of horseshit that makes people vote for Trump
The POETUS's HHS guy will relieve you of any uncertainty - your "research based paleo doc" (who, pro tip, predominantly treats suckers), will be all on your nickel.
As with most law written to regulate commercial activity, the parties regulated by ACA were "intimately" involved in crafting its terms. This method of shaping commercial regulation has been the case since, well, the invention of government. Insurers OWN their regulators, and they really really like it that way. They like owning their regulators so much that they've managed to keep their dark corner of the financial services realm regulated principally at the state level. ACA is a fairly large new exception to that.
ACA brought some modest degree of standardization to both the design and communication of health coverage. That Summary of Benefits and Coverage you posted is one example - a consumer "nutrition label" feature unavailable (because not required) before ACA, and an ACA provision that people of all political persuasions, ages, genders, and income levels report is VERY popular.
But that's slated to go away now. Too bad for you. But you voted!
Hmmm. Your post is a bit difficult to decipher.
Do you have any document(s) you can share that describe features of this coverage your employer offers? Stuff like how much you contribute to have coverage, what you pay if/when you get treatment, etc.
Look for a blue-tinted document called a Summary of Benefits and Coverage (SBC). It looks like this. Your employer may have provided you a pdf of the document; if so, post a link to it.
Then just add the amount you contribute monthly to be covered, because your SBC will not include that info.
Seems like you have the right general analytical concept, which is to focus on your total cost of coverage under each option. Total cost of coverage = your annualized premium costs (the easy part - although the link you've provided returns a 404 error....) PLUS your best forecast of your share of any bills for treatment (that part's harder).
Both of your plan designs are somewhat unusual in that they appear to apply a one size fits all coinsurance formula to any sort of prescription. On that basis your $500/month Rx alone will cost you at least $2,400 over the year, excluding your contribution cost (that darn 404 error).
Rx pricing may depend on each plan's formulary. You should be able to get information at that level of detail from links in your Summary of Benefits and Coverage, which looks like this
>Any other information we need?
daneslord's suggested you provide "EOBs" for your plans but what s/he probably means is to grab your SBCs - Summaries of Benefits and Coverage - to compare feature by feature. SBCs look like this. They're typically available as PDFs.
With them in hand, you could use the crude but effective - and free - SBC comparison tool described here to compare your plans feature by feature (full disclosure: I created the utility). Note that SBCs do NOT supply info on premiums or contributions you may be obliged to pay. That part of the comparison you have to do yourself.
But tl;dr, I mostly agree with Doc_Lee...(my default position) ;-)
It's not a good company probably scammy. https://www.trustpilot.com/review/www.firstquotehealth.com In today's world you need to do a lot of research before you give someone your info. Just type the company name plus review and see what's up.
In order to get ACA coverage for dental you must have a health insurance plan through the exchange. If your employer offers a plan and its premiums are considered affordable, which is less than 9.66% of your income, you will not qualify for a subsidy.
It is hard to know your best option without knowing more details. A dental payment plan group may provide the best benefit but you could also try working directly with the doctor. Some will be willing to cut you a discount if you pay at time of service. When my wife had her cavities filled the dentist only did a few at a time making payment more manageable.
If you are worried about income I know some community health centers have a dental office inside. I know some have sliding scale fees based on income for health but I am not sure about dental.
Lastly, you could try dental tourism to a lower priced country like Mexico. Just make sure you do your research on the doctors there.
Find out the last date you were covered by your mom's policy. You state she applied in March but paid 24 days late, so I assume you've been without coverage since then, or 6 months. You may qualify for a "Special Enrollment Period", click the link and fill out the questionnaire. If you qualify, you may be able to attain coverage. https://www.healthcare.gov/screener/
If you do not qualify, you may not be able to attain coverage until open enrollment which is November 1 through January 31.
You may have to pay a fee for lack of insurance coverage, which for 2016 is 2.5% of your household income or $695 per adult and $347.50 per child, to a maximum of $2,085. https://www.healthcare.gov/fees/fee-for-not-being-covered/
The fee actually isn't horrible (worst case:$173.75 per month) , so it may be easier (and less stressful) to wait till open enrollment. But do try to find an exemption for yourself, or a way to purchase coverage through the marketplace immediately; you don't want to be without coverage when it matters the most.
I hope this helps a bit!
edit: forgot a link
Are you married in the United States, officially? I don't believe she can get coverage until she has the greencard as your spouse, but I'm not sure. You can start here: https://www.healthcare.gov/immigrants/immigration-status/
If it ends up that you can't add her until she has a green card (there was a similar post a while ago), it's okay, cause a change in immigration status opens a special enrollment.
What do you mean buying your own plan not through the marketplace ?
>moving to another state
this may be your "get into health coverage via a Special Enrollment Period card". Check it at Healthcare.gov (I'd be more specific but you didn't list your to/from state).
It sounds like you are on a Government-sponsored plan, like Medicaid. The eligibility is guided by the Federal Poverty Levels, which can be found here: https://www.healthcare.gov/glossary/federal-poverty-level-FPL/
Most states have expanded Medicaid, so the limit is 138% of the FPL, but in a lot of states there's a higher limit for pregnant persons and children.
> If you voluntarily leave, the only option is something called COBRA.
This isn't true. Losing employer-based coverage is a qualifying event, pretty much regardless of why you lost the coverage.
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
I think finding an insurance broker to help you through this would be the best course of events. Otherwise, if you're going to do it yourself, the easiest for a small company is almost certainly going to be using the SHOP marketplace. At 9 people you could probably just have a group discussion to see if there are any insurance companies they refuse to deal with, if anyone would refuse to join an HMO and that kind of stuff to narrow down the list a lot, without prying into anyone's privacy and health problems. Print out the cheapest HMO, cheapest PPO etc and see if there are any complaints.
It's kind of a curious thing - ACA's special coverage change rules are narrower than IRS rules governing changes in employer-sponsored plans featuring pretax employee contributions - the rules for employer-sponsored plans CAN permit changes for the situation you are in. Maybe you should file an appeal?
That depends on exactly how long "a few months" is, but it looks like if you don't have coverage start in the month of February you'll end up paying. You may want to look at the below website.
If you make less than 100% FPL (which you currently do) and live in a state that hasn't expanded Medicaid (which NC didn't), you qualify for a hardship exemption and don't owe a penalty. https://www.healthcare.gov/exemptions-tool/#/results/2015/details/secretary-hardship
>Also do I have to enroll in insurance now that it is "open enrollment" or can I get it in march when I lose my parents health insurance?
You'll have a "special enrollment period" then, so you can wait if that works for you.
BUT.
You may want to shop, because you may find you can suitable coverage on your own, at a lower cost for your parents than keeping you as a dependent on their plan - mainly because depending on where in MI you live, you may be eligible for premium subsidies.
You can shop on Healthcare.gov, or at other sites. Plans,premiums, signup etc will be the same, though technical features & functionality may differ.The "private label" sites also propose that their service will be better/faster/more effective for you than Healthcare.gov.
Here's a link to my "branded" "private label" site. You can try it out; just as at Healthcare.gov, you're not forced to buy anything to shop prices
>If you can’t submit to insurance, could you submit it as an HSA-eligible out of pocket expense?
HSA reimbursements don't require you to submit any expense receipts.
Instead, take a self-distribution from the account, receive Form 1099-SA at tax time, complete and submit Form 8889 with your annual tax return, and keep the receipt with your tax records in case the IRS chooses to audit your tax return for accuracy.
​
>And if so, how are expenses incurred abroad in other currencies handled when your HSA is in denominated in $USD?
Use any reputable currency exchange website to determine the rate on the date of service. Just print out the exchange result and keep it with your tax records.
Gaining other insurance is considered a qualifying life event. So, you'd get the individual insurance now, and then you'd inform the exchange that you have gained other insurance and will be able to cancel the plan. https://www.healthcare.gov/reporting-changes/cancel-plan/
I would consult: https://www.healthcare.gov/income-and-household-information/
I think they just want you to take an educated guess.
I also googled "ACA and freelancers" and lots of articles came up.
Hope this helps.
No.
Anything else?
No, seriously, while it's simpler now, with the advent of Obamacare (Affordable Care Act), than it was previously (all that business about pre-existing condition limits, etc) it's not "simple", in the sense of "you can switch every month if you want to".
I won't go into the variations of enrollment options nowadays here, other than to provide a link to some technical stuff, but basically you can make an annual election of a different plan and/or insurer during the fall, with the new coverage taking effect January 1, unless you qualify for a special enrollment period, in which case you can make a mid-year change.
how's that for starters?
look for your Summary of Benefits & Coverage (SBC). It looks like this. All providers of health coverage are obliged by ACA to provide a copy of this "nutrition label for health coverage" - typically as a PDF - to people covered by the plan. It may have been sent to you via email. SBCs include information on your maximum out of pocket spending limit.
Have you checked your coverage ID card? There may be a phone # and/or website URL at which you can obtain this information and/or a link to your plan's SBC. Make sure you find the SBC for your plan - an insurer can & typically does offer a variety of policies.
the new penalty repeal doesn't take effect until 2019. if you go without coverage in 2019, you won't pay a penalty when you file taxes in 2020. so you still need health insurance this year if you want to avoid the fee.
if you're losing a job you should qualify for special enrollment. you can pick a "catastrophic plan", which is the lowest premium but you would pay the most out of pocket in the case of an emergency. you could also do COBRA to continue your employers healthcare plan until you get a new job.
healthcare.gov can tell you more about whether you qualify for special enrollment, or for medicaid: https://www.healthcare.gov/screener/
You don't apply at all right now if you don't qualify for a special enrollment period (check here to see if you do).
If you're losing coverage - maybe from a parent's plan, or school, etc - you may qualify. If so, shop at the federal exchange, or via an site like HealthSherpa
Ok, so we're passed the open enrollment period. However, you might qualify for a special enrollment period. These are the events that trigger a special enrollment period.
TL:DR Sorry, can't provide one. Read the whole darn thing.
Hiya. The easiest way is to know what we're up against. What is the county you will be in, the age and sex of everybody in the family, and income. Because you are self employed, I need the income after you write off business expenses, but before you write off personal deductions.
Every insurer is required to cover certain basic things. All carriers are not created equal, however an educated person, with a nudge in the right direction, can get what they need. Insurance is a regulated industry, and so long as you know what the regulations are (that's what this sub is for), you'll be fine.
Re: state lines. All insurers cover emergency rooms and urgent care nation-wide, (with the exception only of Humana's narrow network products, which only cover ER visits nation-wide). BTW, Humana narrow network may be the 3rd or 4th layer of hell.
Regarding Health insurance and cost. Health insurance exists to prevent an unfortunate event from becoming a financial disaster. The cost to treat breast cancer w/o insurance can easily hit 100K. Every health insurance plan (assuming you stay in network) will limit that to a maximum of 6K (that's the extreme, most plans are half that).
So let us help you find the plan for you. We don't get any commission for it, we just take your info and plug it into the exchange. We're professionals, and we're here to help.
Im not in charge of making that decision, but there is a list of criteria that healthcare.gov uses to determine enrollment eligibility outside of the open enrollment window https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
EDIT to clarify, if a company decides to accept a slightly late payment, the customer still has to pay all the way back to their date of enrollment, ie 1/1/18. If the customer is eligible for a special new enrollment, their coverage will start on whatever new date they are able to apply for, eg 3/1/2018, and they wont be covered for anything before that date.
Can you elaborate? I was under the impression that COBRA had some restrictions about when you could terminate it. At least that's how I read this chart (which is specifically about job loss triggering COBRA, while my wife was aged off her parents' plan - not sure that matters):
Here's a link to the .gov site, just scroll down to "loss of health insurance" then "losing job-based coverage." It doesn't say directly that quitting is ok, but it doesn't say it's excluded.
Here's a link from insure.com that specifies quitting a job is a qualifying life event.
Sorry, I would type more but my kid is being a pain in the ass lol
Sorry for your loss! :(
Yes, a change in residence is a Qualifying Life Event. Other options include taking a plan through an employer or through university.
Absolutely correct. Deviating from the below list changes things from a preventative visit to a routine office visit subject to deductible and copay/coinsurance.
https://www.healthcare.gov/coverage/preventive-care-benefits/
I think you have to check if you're eligible for Medicaid in your state. As far as I understand, at least in my state: 1. Only real (they will ask for proofs) current income counts, not something you see in crystal ball 2. Everything is "reset" on 1 Jan, and if you were making six figures before, it doesn't matter.
BTW if you put something below 138% FPL as income healthcare.gov will likely (for "expanded medicaid" states I believe) send you to your state Medicaid agency.
For Obamacare they have some guidelines:
https://www.healthcare.gov/unemployed/coverage/#unemployedincome
But they will ask for proofs of income anyway. And I have no idea what is the proof of income for unemployed.
With a policy purchased through the ACA exchange, you might qualify for some assistance, maybe even free care through Medicaid. I would recommend you at least look at the plans available there (Delaware uses the federal exchange): https://www.healthcare.gov/ All plans offered on the exchange have to meet certain standards (they're "creditable coverage") and will give you real protection should anything go wrong.
The IHC Edge STM policy isn't creditable coverage and should be avoided if you have any other options. According to some digging I did on the IHC website, their policies are only 90 days. This means that the $3000 family deductible resets every 90 days and is actually more like a $12000 family deductible. It also excludes pre-existing conditions which is especially insidious in 90 day policies - one of your little ones (heaven forbid) has a nasty fall and needs physical therapy. Once that 90 day policy expires, wham, the fall is now a pre-existing condition and the PT isn't covered any more.
Awesome! I would have your employer fill out the form on healthcare.gov. On top right is search bar. Type in employer coverage tool form.
There should be a few results.
https://www.healthcare.gov/have-job-based-coverage/change-to-marketplace-plan/
A bit down the page you should see blue text for employer coverage form
https://marketplace.cms.gov/applications-and-forms/employer-coverage-tool.pdf
Have them fill this out ASAP. It will tell you if it’s considered affordable and if it’s not. If it’s not you can use that as proof to marketplace to get coverage. ( if the application asks for said proof and the employer usually is contacted as well)
OK, so you're in a state that didn't expand medicaid. HOWEVER, this is a run around this sort of thing.
First, if your school offers it, get on their student health insurance.
If not, one of the things that triggers a special enrollment period is relocation. Basically, you need to change zip codes. Once you've done that, you've "moved" and are eligible for a special enrollment period.
sauce is here
I entered a random zip code from Wisconsin, $23000 for income, and age 33 - qualify for subsidy of $485/month. Found this plan
Go to this website:
https://www.healthcare.gov/see-plans/
Input your personal information to see if you are eligible for subsidy, and to see what plans are available in your area.
Keep in mind that Farm Bureau plans can price-discriminate based on your health status, while Marketplace plans (Healthcare.gov) cannot.
If you are determined ineligible for Medicaid, then you will be eligible for a Special Enrollment Period on HealthCare.gov, so there is no need to apply for a marketplace plan while you wait for your eligibility letter.
Source: https://www.healthcare.gov/sep-list/ (see "Being determined ineligible for Medicaid or CHIP")
Maybe some options are only have child with insurance, (Bronze or Silver), everyone with Bronze, or parents with bronze and child separately with silver.
Catastrophic plans are the least expensive and are available to people under 30 years old, or have "hardship exemptions." There is a form and a list of events that qualify as hardship. I'm not sure how to view catastrophic plans on the website. Maybe it automatically shows up if you're under 30. $480 to $1200 is a huge jump. If it was a grandfathered plan from a long time ago back when premiums were cheaper, this might qualify as a hardship. https://www.healthcare.gov/choose-a-plan/plans-categories/
There's also a penalty for not having qualifying coverage, but it's probably less than the annual cost of coverage. https://www.healthcare.gov/fees/fee-for-not-being-covered/
You qualify for Cost Sharing Reductions because your income is between 100% and 200% of the Federal poverty level. Your brother is above the limit. These reductions help to lower your deductible, copays, and out-of-pocket maximums. You can find out more at the link below.
A scan of a few states using Healthcare.gov's extra help calculator suggests the upper bound of income to qualify for extra savings is around $30k - Mississippi, North Carolina, Texas, etc.
In other words, in those states, brother WOULD qualify for extra savings in the plans' benefit features.
I didn't check any states running their own marketplaces.
So, OP - where are you?
When applying for a subsidy you use your Modified Adjusted Gross Income. MAGI is your standard AGI (Income before taxes) with a few deductions added back in.
Healthcare.gov actually has a good page explaining what is and isn't counted as income. If you have any questions, you can call their 800 number as they are really quite helpful.
>Can you buy group insurance among a group of friends?
no
>how long could you go without insurance without getting penalized?
You might think there's a simple answer to this question. You would think incorrectly: see this Healthcare.gov page for the intro to the matter of coverage gap exemptions....
That is one of the big reason's why healthcare.gov exists, to make buying health insurance easier.
You do want to make sure you choose the correct plan for your needs. There are many ways to get help picking a plan that is right for you and going through your options. Below is a link on how to get in contact with those sources.
Covered CA is the state's health care portal. It includes help with medicaid and other state-level social programs, as well as assistance with access to federal programs like "the exchange" aka "obamacare insurance". The can help you figure out what all you can apply for, and what paperwork you need. You can also contact the feds directly. There will be some paperwork you need, and CA is one of the better states as far as assistance with such things, which is why I think you might want to stay in touch with them.
http://www.coveredca.com/ https://www.healthcare.gov/glossary/special-enrollment-period/
You may qualify for a hardship exemption that would allow you to enroll in a catastrophic plan at a lower cost (About $200 per month). Because the lowest cost bronze plan exceeds 8.16% of your income (About $408 per month) you should qualify. More information is in the link below.
https://www.healthcare.gov/health-coverage-exemptions/forms-how-to-apply/
that makes no sense. The Marketplace is the the federal insurance exchange, which ultimately "runs" AMbetter. They determine your enrollment in any subsidized health insurance. DHS (Im assuming) is your state Department of Human Services, which runs Medicaid. To get the status of your current insurance through the exchange/ aka marketplace, call https://www.healthcare.gov/contact-us/
the procedure (the actual sticking of the tube and all that) is covered under the ACA as preventative screening for cancer. If your Dr codes it (correctly) as a screening for damage due to ulcerative colitis, it isnt a screening for cancer. Anything beyond a screening is not covered under this rule at all, and is only covered under the terms of your individual policy.
https://www.healthcare.gov/preventive-care-adults/ https://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancer
My thought is this: Contact the Marketplace via mail (go to https://www.healthcare.gov/contact-us/ and choose "mail > documents for applications/inconsistencies") and send a reasonably succinct summary of the dates of each of the new enrollments and a list of what youve done. Send it certified. They will (hopefully, they should) reach out to you, and let them explain what they need, in order to correct the problem. If they are not responsive, talk to your congressman. Thats my 2 cents.
yes, 60 days. plus SEP for unusual circumstances https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
this year the open enrollment period will start 11/15/17 for coverage beginnning 1/1/17. Im not sure when it will close, it may be sooner this year (12/31/17) but Im not sure about that. What will happen in 2018??????????
The only thing you can do now is enroll as a SEP, if you qualify. It sounds like you've considered that, but you should rescrutinze the guidelines. https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
There may be local programs that can provide some assistance but it wouldn't be coverage as it's called in the ACA, and in IRS world
there are concessions to insurers in the ACA. Not letting people sign up for insurance whenever they feel like it, massively cuts down on people who sign up only to get medical care, and then dis-enroll when they are done, as well as lets insurers manage their membership in a more comprehensive/stable fashion, and lowers administrative bloat (yes it could be worse). There are special exceptions built in to the ACA as well. https://www.healthcare.gov/glossary/special-enrollment-period/ Warning, next round of the ACA or AHCA or whatever, will probably be stricter in this regard.
My suggestion would be for you to get on your parent's plan and get government assistance for you child through "The Children's Health Insurance Program". You can learn more about the program here: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/
First verify that you don't meet any of these criteria https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
I'm assuming there's no way you'd qualify for Medicaid?
Talk to a local independent insurance agent, they are most likely to be familiar with what's available in your area.
Get the cheapest high deductible plan aka HDHP they have. Whatver your monthly premium, put another half that into an HSA (health savings account) every month. Your girlfriend should have her own account. That'll approximately equal what your employer would spend and you would spend in a year, for tradition commercial insurance. Hopefully you'll end up with some money saved up for whatever life throws at you, and in the meantime pay out of pocket for routine care. http://www.consumerreports.org/health-insurance/high-deductible-health-plan/
>her parents and their insurance company are in Utah
I like danes' advice, but this bit concerns me. Check insurer's website, or call the service # on the back of your (or wife's?) ID card and ask them to send you a link to the Summary of Benefits and Coverage (SBC) for your plan. It looks like this. This 8-10 page document provides you basic information on your plan & coverage along with contact information for more details. All plans are obliged to make it available to any covered person.
If your insurer can't provide this document, consider it an alarm bell - not the end of the world, but a sign that you need to dig further for what kind of coverage you have, and more details on how it works.
> you pay the first $2500 of bills.
you pay the first $2,500, then 10% of bills over that to your annual out-of-pocket cap.
BUT in the meanwhile various preventative visits/screenings are available to you BEFORE you've paid your deductible.
Look for your Summary of Benefits & Coverage (SBC). This 8-10 page "nutrition label for health coverage" looks like this. Your plan is obliged to provide you one and they usually do so a a PDF. If you don't have it, visit your plan's website/webpage, or call the customer service # on your ID card.
That’s because you don’t need a prescription for it, you can buy it over the counter. Amazon has it for $5.46 for 200 pills.
There's lots of misinformation being handed out by people who should know better. That being said, have you looked over this list? If you've moved lately that might count. https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
> I don't want to wait until next month to apply with my new job, as that will cause a gap in insurance.
Hmmm.....not necessarily. But the simplest way for you to get on the right track, process-wise, is to contact Marketplace staff & relate your situation.
Health insurance costs depend on a multitude of different factors. The person you spoke with that is paying $50/month for the employee contribution most likely has very generous employer contributions.
Have you tried SHOP through healthcare.gov? It's the exchange for small businesses. https://www.healthcare.gov/small-businesses/employers/
do you have the SBCs for the different plans? here is a blurb, and under "more answers" there are some examples of what you are looking for. https://www.healthcare.gov/health-care-law-protections/summary-of-benefits-and-coverage/
1) The fee for not having health insurance in 2016 & 2017
The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.
Percentage of income
2.5% of household income
Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace Per person
- $695 per adult
- $347.50 per child under 18
- Maximum: $2,085
2) there is no concern with pre-existing conditions currently
3) with an HMO you require a referral from you PCP to see a specialist. You should determine first if your current therapist is in network. If they are, determine what insurance they accept and try to find a plan on the marketplace the therapist accepts. If they do not, you either pay out of pocket for services, or look into a PPO with out of network benefits, so you can receive ~50% reimbursement for charges after you meet the deductible.
4) you can look into community resources for therapy services. What medications are you on?
You should apply through Marketplace during the enrollment period. You mentioned that your parents are on Medicaid so I'm assuming they are below the income threshold for a premium tax credit. Your income level should also qualify for Medicaid. So if you want a plan through ACA you will most likey pay the full price since people that are Medicaid eligible get no premium credits.
There are alot of variables that I won't get into right now. You can apply through the state where you go to school on a separate application if your parents don't reside in the state as well.
I'd suggest getting a short term medical plan through the end of the year. Many of these plans allow you higher deductible options which will help keep premiums down.
Then during the annual enrollment fill out an application on the Marketplace website or by calling them. If the information you enter suggests Medicaid coverage you can have the application rolled over to your state Medicaid agency and they will give a final determination on your eligibility.
This link should give you some insight on how to apply through the marketplace.
You can retro into cobra for 60 days after you get your offer letter, but I personally wouldn't want to try to do that on day 55and not have it work out. And that still leaves you in the lurch if you go past 60 days.
The price and type of coverage you are going to get from plans like the United plan, is about all you can expect from any short term plan. Your other options would be cobra or if you qualify, coverage through healthcare.gov.
https://www.healthcare.gov/glossary/special-enrollment-period/
Here is some information. Not sure if this helps or not.
Be very careful with attempts to procure insurance through websites and "brokers" advertising over the internet as there are a lot of false sites and scammers. Better to either deal directly with Healthcare.gov or a local insurance agent/broker in the city you'll be moving to.
I looked into temporary insurance recently and the policies I found offered very little coverage and did not cover pre-existing conditions as they were not required to conform to ACA (Obamacare) standards like regular health insurance coverage does.
Oh and that's a good point, I don't know the specific duration of days, but yes you need to keep current coverage to get access to healthcare here. Or, you may also fall into a "qualifying event" which gives you access to the ACA insurance (vs. private) which MAY include relocation to the states. Though I am in HR, not an expert so keep researching :).