I am a Tempe resident for 24 years, with my original roots from Huron, South Dakota, I specialize in Individual & Family Health Insurance, Medicare, Medicare Advantage Plans, Medicare Supplement, Medicare Prescription Drug Plans, Small Business Health Insurance, Life Insurance, Dental Insurance, Vision Insurance, Critical Illness Insurance, Disability Insurance, Accident Insurance, Long-Term Care Insurance, Wellness Products
Thursday, September 1, 2022
Hey, I bet you didn’t know its National Life Insurance Month!
Wednesday, June 22, 2022
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.”
48513-HM-0522
Saturday, April 2, 2022
I Lost My Job! Should I Do COBRA or ACA?
I Lost My Job! Should I Do COBRA or ACA, or a Short Term Plan?
Losing your job comes with many
headaches, including a change in health insurance in many cases.
COBRA coverage is one option, but so is a plan under the
Affordable Care Act (ACA). So how do you know which one to choose? The decision
may be easier than you think.
What’s
the difference between COBRA and ACA?
It may seem like you’re wading through alphabet soup
when you look at these two options. Start by understanding what
each one is.
COBRA, or the Consolidated Omnibus Budget
Reconciliation Act, allows you to stay on your employer’s group health plan at
your own expense, says Tasha Riggs, sales leader
for HealthMarkets in Westminster, Colorado. It also covers
your spouse and any dependent children if they elect to be on the plan.
The most important thing to know: You’ll pay the
full cost of the premiums, including the
amount your employer used to pay. You might also pay an
additional 2% administrative fee, says Katie Keith, JD, MPH. Keith
is an associate research professor at Georgetown University’s
Center on Health Insurance Reforms in Washington D.C. who specializes
in the Affordable Care Act and private health insurance.
ACA plans, or Affordable
Care Act plans, refers to individual health insurance plans that meet the minimum
essential coverage and other requirements set by the
federal government.
“People often think that there’s a government
plan called ‘Obamacare’ or ACA and a separate private market, but there’s not,”
Riggs says. “ACA is a law, not a healthcare policy. Every major
medical plan has to comply with it.”
Feeling overwhelmed? Let a HealthMarkets licensed
insurance agent help you sort
through your insurance options. Start online today or call us at (605)
838-8330.
COBRA
vs. ACA: How to Decide
Several factors can help you determine
whether COBRA or ACA is better for you.
1. Consider the cost. “For
most people who just lost their job, COBRA is too expensive,” Riggs
says. ACA plans tend to be much cheaper than COBRA
rates. “If your adjusted gross income fits the guidelines, you can get a
premium subsidy,” she says. How much the subsidy lowers your monthly
premium depends on your age, who’s on your tax return and whom you
claim, your ZIP code, and adjusted gross income.
2. Check your deductible. When you switch
to an ACA plan, your deductible will reset. But if you opt for COBRA,
you’ll keep any progress you made toward your annual deductible while you were
employed.
“Those deciding between COBRA and ACA coverage will want to
consider how much they have already expended toward out-of-pocket costs,
whether they expect to need additional care (or, say, have a chronic
condition), and the time of year,” Keith says.
For instance, if you’re close to the
end of the calendar or plan year, it might make sense to sign up
for COBRA before shifting to ACA coverage. To figure
it out, you’ll want to add up the cost of COBRA
premiums for the rest of the year against potentially higher
out-of-pocket costs with an ACA plan.
If you’ve met your deductible and are close to (or have
reached) your out-of-pocket maximum,
your remaining COBRA payments might be
less than starting a new plan with a brand-new deductible.
3. Think about whether you’re open to switching physicians. “No
matter what plan you have, you have to see if your doctor is in network,” says Riggs. Networks change
regularly, so it’s important never to assume your doctors will be covered.
If you want to keep your doctors, make sure they
accept the new plan you’re choosing. This is especially critical
if you have ongoing healthcare needs or chronic conditions and need to
maintain access to your providers for continuing care, Keith says.
4. Pay attention to timing. People who
lose their job-based coverage generally qualify for a 60-day special
enrollment period through the ACA marketplace.
That’s true even if you’re offered COBRA, Keith says. That means you
have about two months to decide what to do.
However, if you choose to enroll in COBRA,
you have to stick with that plan until the policy ends or until
the annual ACA Open Enrollment
Period, says Keith. You can’t switch
to marketplace coverage simply because you want to drop COBRA coverage
midyear.
So which should you choose?
The answer, of course, depends on your current situation,
which includes everything from your family medical
needs to the names on the tax return. The good news?
You don’t have to navigate the decision alone. If you need help
reviewing your options and finding the right
plan, HealthMarkets licensed insurance agents can help at no
cost to you. Start online today or call us at (605)
868-8330 or in AZ, NM (480) 400-9837.
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