Have you recently had a qualifying life event? “A qualifying what?” you might ask.

 

Have you recently had a qualifying life event? “A qualifying what?” you might ask.

What is a qualifying life event?

A qualifying life event could be a situation like losing your job, having a baby, moving to a new state, or becoming a U.S. citizen. These events not only open new chapters in your life but also a window of opportunity—or a Special Enrollment Period (SEP)—to purchase healthcare coverage through an Affordable Care Act (ACA)  plan.

There are good reasons to get one of these healthcare plans: They can’t deny you service or raise your rates because of a preexisting condition, for example. And if you fit certain income categories, you may be able to save money with certain tax subsidies (discounts offered by the government). But your ability to join is usually limited to an Open Enrollment Period, which runs from the beginning of November to mid-January.

Now, here’s the good news: You may be able to get one of these plans at other times of the year too, if you meet certain qualifications, says Ryan Newport, a licensed insurance agent with HealthMarkets in Oklahoma City. “I get asked this question all the time, and the answer is often yes, for more reasons than you might think,” he notes.

Before you start, try researching out to Greg Ninke, your local HealthMarkets agent at (605) 868-8330, (480) 400-9837or connect online to discuss your options. Schedule an appointment today.

10 qualifying life events that may trigger your special enrollment period

Here are 10 reasons you may qualify to purchase ACA health insurance benefits outside of the Open Enrollment Period.

1. You lost your health coverage.

You’ll be able to enroll in ACA benefits if anyone in your household lost their health coverage in the past 60 days or expects to lose coverage in the next 60 days, says Newport. That can happen for a few reasons:

• You lost your job and thus your health insurance.
• You lost individual health coverage for a plan you bought yourself. That could be because your plan was discontinued, you moved to another state (and you’re no longer in the plan’s service area), or your coverage is ending midyear and you’ve chosen not to renew it.
• You’ve lost income. If your household income has decreased and you now qualify for savings on a marketplace plan, you can enroll in ACA benefits.

You may need to submit a letter from either your employer or your health insurance provider to confirm that the top two things have happened.

2. You lost eligibility for Medicaid or the Children’s Health Insurance Program (CHIP).

A gain in income is always great news, but it may make you ineligible for Medicaid, points out Newport. (Medicaid is a type of state- and federal-run healthcare program that’s offered to people who have limited income and resources.) Also, once your children get to a certain age (usually 19), they may be too old for CHIP. (CHIP is low-cost healthcare coverage for children in families that earn too much money to qualify for Medicaid.)

3. You lost qualifying health coverage through a parent or spouse.

That might have happened for a few reasons:

• You turned 26 and have been automatically removed from a parent’s health plan.
• Your spouse or parent lost their job—and with it, their health insurance.
• You lost health coverage through your partner because you got divorced or your partner unexpectedly passed away.

4. You’ve gained coverage through a parent or spouse.

Talk about a happy life event! Getting married, having a baby, and adopting a child are all considered qualifying life events that make you eligible to sign up for health insurance benefits.

5. Your boss offers to help pay for your insurance.

The most common way that this occurs is when a small company (less than 50 employees) that doesn’t offer a group health plan offers to reimburse some or all of the cost of marketplace premiums (monthly insurance bills) through a Qualified Small Employer Health Reimbursement Arrangement. You’ll need to apply for and enroll in individual health insurance before that begins.

You could also contact your licensed agent Greg Ninke at at (605) 868-8330, (480) 400-9837 to talk about what insurance benefits might be right for you.

6. You have a change in residence.

So you’re on the move. But this is about more than just moving to a different ZIP code. Maybe you’re a student going off to graduate school, a seasonal worker moving to the place where you’ll be working, or you’re someone who is moving into a shelter. The new plans available in your area may be the next thing you unpack.

7. You just became a U.S. citizen.

Congratulations! Becoming a U.S. citizen is hard work. One of the many doors that will be opened to you is being eligible for health insurance benefits.

8. You just got released from prison.

If you’ve recently been incarcerated, your first taste of freedom could also include an open window to sign up for health benefits.

9. You’re starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member.

Government-run agencies such as AmeriCorps State and National (which send volunteers to work at nonprofit organizations), AmeriCorp VISTA (a national service program designed to alleviate poverty), and AmeriCorp NCCC (National Civilian Community Corps) are all great ways to serve your country. And if you’re beginning or ending your time with one of them, it can also trigger an SEP that allows you to register for health benefits.

10. You gain membership in a federally recognized Native American tribe or get status as an Alaska Native Claims Settlement Act corporation shareholder.

Congratulations on officially joining your Native American community or your new shareholder status! Now, it’s time to review the new health insurance options available to you.

But wait! What happens if I get turned down?

If you fit into one of the above categories but still get turned down, you can appeal the decision within 90 days, notes Newport. If you think waiting out the decision may seriously jeopardize your health (for example, you won’t be able to pay for your medications), you can ask for a faster appeal.

If you think you may qualify, don’t hesitate to chat with me at (605) 868-8330, (480) 400-9837or connect with Greg Ninke online.

“Life changes happen pretty quickly, and it’s good to know that you’re covered,” says Newport. “If you move to another state, for example, you may not know the ins and outs of obtaining health insurance through the state marketplace. Your agent can help find you a good plan that’s the best fit for you and your family.”

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8 Things Medicare Doesn’t Cover

 You’ll need to plan ahead to pay for some common medical expenses

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Medicare covers the majority of older Americans’ health care needs, from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t a part of the program — and how you might pay for them.    

1. Opticians and eye exams

While original Medicare does cover opthalmologic expenses such as cataract surgery, it doesn’t cover routine eye exams, glasses or contact lenses. Nor do any Medigap plans, the supplemental insurance that is available from private insurers to augment Medicare coverage. Some Medicare Advantage plans cover routine vision care and glasses.

Solution: For some people, it makes sense to buy a vision insurance policy for a few hundred dollars a year to defray the costs of glasses or contact lenses. Contact me at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of all the Eye and Dental options available to you!

 

2. Hearing aids

Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids. 

Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices. Also, some programs help people with lower incomes to get needed hearing support. Or you can pay as you go. Congress passed legislation in 2017 that allows some hearing aids to be sold over the counter without a prescription. The Food and Drug Administration has until August to issue proposed guidelines for the sale of these devices.

3. Dental work

Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.

Solution: Some Medicare Advantage plans offer dental coverage. If yours does not, or if you opt for original Medicare, consider buying an individual dental insurance plan or a dental discount plan. Some have no waiting periods, some do. Contact me at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of all the Eye and Dental options available to you!

4. Overseas care

Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S. 

Solution: Some Medigap policies cover certain overseas medical costs. If you travel frequently, you might want such an option. In addition, some travel insurance policies provide basic health care coverage — so check the fine print. Finally, consider medical evacuation (aka medevac) insurance for your adventures abroad. It’s a low-cost policy that will transport you to a nearby medical facility or back home to the U.S. in case of emergency.  Contact me at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of Medigap/Supplement or Travel options options available to you! Or visit GeoBlue

5. Podiatry

Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment if it is related to nerve damage because of diabetes, or care for foot injuries or ailments, such as hammertoe, bunion deformities and heel spurs.

Solution: If you face these costs, you may want to set up a separate savings program for them. 

6. Cosmetic surgery

Medicare doesn’t generally cover elective cosmetic surgery, such as face-lifts or tummy tucks. It will cover plastic surgery in the event of an accidental injury.

Solution: If you face these costs, you also may want to set up a separate savings program for them. 

7. Chiropractic care

Original Medicare does not cover most chiropractic services or the tests that a chiropractor orders, including X-rays. Medicare Part B does pay for one manual manipulation of the spine by a chiropractor or other qualified provider to correct a vertebral subluxation, which is basically a partial dislocation of a spinal vertebra from its normal position. 

Solution: Some Medicare Advantage plans will cover chiropractic services, so check with your plan. Some chiropractors offer payment plans to help you pay for this care.

8. Nursing home care

​Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you become so frail or sick that you must move to an assisted living facility or nursing home, Medicare won’t cover your custodial costs. (Nursing homes average about $90,000 a year for a semiprivate room and more than $100,000 for a private room. Costs vary based on where you live and what facility you choose.)

Solution: Planning for nursing home care is a big issue, with lots of choices and decisions. But for those with limited income and savings, Medicaid might help fill in the gaps. Contact me for information on Long Term Care plans and other creative solutions that may fit your situation at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of all the Eye and Dental options available to you!