WHAT ARE YOUR HEALTH INSURANCE OPTIONS |
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Whether a marketplace plan, a COBRA plan, or a short-term health plan is best for you depends on costs each month and what you want from a health plan. Choosing a health plan takes both research your options and taking into consideration your individual situation. You should think about both your health and finances.
When you’re looking for an individual health plan, you need to figure out:
You’ll also want to figure out your financial situation:
After exploring these topics, you can figure out what’s the best health plan for you. Coverage through the ACA Marketplace is one way to get coverage. Each year the ACA has an Open Enrollment from November 1st until December 15th where you can sign up for coverage for the following year with “Guaranteed Acceptance”. Another option that the federal government expanded in recent years is "Short Term" health plans. These plans can be lower in cost but, if you have any health issues or expect to need many health services in the next year, you may want to find an inexpensive ACA plan. Short Term plans will not cover pre-existing conditions. *Right now the ACA Health Insurance Marketplace has announced a "Special Enrollment Period" for the rest of 2022. This means if you qualify you can get health insurance coverage with "Guaranteed Acceptance" and do not have to wait for the normal November 1st "Open Enrollment".* Qualifications are based off of household income. If you don't have health insurance, call our office to see if we can help you get the coverage that you need right now. |
ACA Health coverage provides true major medical coverage
An ACA plan covers you regardless of previous injuries or pre-existing conditions like chronic illnesses. You cannot be turned down for coverage.
Most working-age Americans have an employer-based health insurance coverage, but an ACA plan is an option for you or your spouse if:
An ACA plan must cover 10 essential health benefits:
“If someone has a chronic condition and medical concerns, they should absolutely be on an ACA plan to get the robust coverage they need. Each year there is an Open enrollment for the ACA health coverage from November 1st until December 15th. During these 6 weeks you can keep the coverage you have now or you can enroll in another plan. You can do all this because during this time period you cannot be turned down due to a previous pre-existing health problem.
An ACA plan covers you regardless of previous injuries or pre-existing conditions like chronic illnesses. You cannot be turned down for coverage.
Most working-age Americans have an employer-based health insurance coverage, but an ACA plan is an option for you or your spouse if:
- Your employer does not offer health insurance
- You are self-employed
An ACA plan must cover 10 essential health benefits:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder
- Prescription drugs
- Rehabilitation services
- Laboratory services
- Preventive and wellness services
- Pediatric services, including oral and vision care
“If someone has a chronic condition and medical concerns, they should absolutely be on an ACA plan to get the robust coverage they need. Each year there is an Open enrollment for the ACA health coverage from November 1st until December 15th. During these 6 weeks you can keep the coverage you have now or you can enroll in another plan. You can do all this because during this time period you cannot be turned down due to a previous pre-existing health problem.
Short-Term health plans can be "An Alternative to COBRA coverage"
People sometimes mistake short-term plans as an ACA plan alternative. Which they are not, because they do not offer comprehensive major medical coverage and coverage can only remain in force up to a maximum of 33 months in SC. Short-term plans have been around for over 20 years. They’re seen as plans to help people who face unexpected accidents or illnesses. They’re not meant as a long-term health insurance plan to cover people with long-standing health issues.
Instead, you may want a short-term plan if you’re out of work or started a new job and don’t have health benefits yet. During this time you should only need coverage for a few months. Laid-off workers often choose expensive COBRA plans to keep coverage for up to 18 months after leaving a job. COBRA plan are very expensive because former employers are no longer kicking in any money to help pay for coverage. So, individuals have to pay the full amount for COBRA coverage. So, you can see that a short-term medical plan might be a more affordable stop-gap then COBRA until you get another health insurance plan.
When comparing ACA vs. Short Term plans, it’s important to know that short-term plans aren’t meant for people with chronic conditions. Instead, they’re in place for “unexpected accidents or illnesses" while you are in between jobs and have no health insurance coverage. Unlike ACA plans, short-term plans don’t have to accept every applicant. They can reject you if you have pre-existing conditions as they would consider you a risk. For instance, short-term plans often won’t give you coverage if you have pre-existing conditions like diabetes, heart problems, kidney failure and recent cancer. Even if you get approved for a short-term plan, it may not cover services found in an ACA plan. One example is that short-term plans don’t have to cover the 10 essential health benefits found in the ACA.
Short-term plans can exempt coverage of those services or place limits on them. An example is prescriptions. Short-term plans may cover medication if you go to the hospital for an unexpected condition. However, the plan likely won’t cover a prescription for pre-existing asthma. Instead, you’d have to pay that all yourself. One good thing about Short Term plans is if you are in good health most plans can start coverage as soon as the next day.
Contact us to learn more about which plan option is best for you.
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