Open Enrollment Starts In November. There’s No Reason To Be Uninsured Until Then
Major medical health insurance (Obamacare/ACA) is not an option for most uninsured Americans until the Open Enrollment Period starts again in November 2019.
If you are finding yourself uninsured and needing or wanting coverage, you have a few other options. We’ll explain them below.
Short Term Medical Insurance
Major medical insurance isn’t always an option for some. If you’ve missed the deadline for open enrollment, for example, or you just can’t afford the premiums and deductibles that come with a traditional health insurance policy, then short term coverage might be a good alternative for you. As the name implies, short term health insurance – abbreviated to STHPs for short-term health plans – is temporary medical coverage. These plans are ideal for people in transition, whether you’ve changed jobs and need something to fill the gap between employer-sponsored coverage, you’ve just graduated college or been dropped from your parents’ plan, or you’ve retired early but don’t qualify for Medicare yet.
Before 2016, STHPs could last from 30 days to a full year in some states, but that has since changed. Now, short term health policies run from 30 days to under three months. They cover limited benefits, don’t include pre-existing conditions and aren’t guaranteed-issue or renewable. Unlike major medical policies, STHPs include maximum lifetime payout limits, and you must meet a deductible before the insurer will pay its portion. Plus, STHPs require you to see in-network providers. If you go outside the network, the plan won’t cover your care unless it’s a true emergency.
Despite some obvious drawbacks, short term health insurance makes sense for certain people. Premiums are much lower for STHPs than for major medical policies, they cover a variety of benefits depending on the plan you choose, and they offer peace of mind if you don’t have major medical insurance but need some kind of protection in place. Combined with other policies, like standalone critical illness protection, short term medical plans can form one part of a decent private benefits package.
A fixed indemnity plan is a plan that can supplement a major medical plan or maybe even a short term medical plan to cover your out-of-pocket costs associated for other medical services – including outpatient care, trips to the doctor for illness or injury, lab work and prescription drugs.
In general, fixed indemnity plans pay out cash benefits for specific covered situations related to hospital and doctor medical care. Sometimes called Hospital & Doctor Fixed Indemnity, the benefits received through these plans can help cover the annual deductibles that you may have to pay before receiving any coverage from your major medical or short term health insurance plan.
Fixed indemnity plans are also more affordable than a major medical plan and consumers may see an average cost of $75.00 a month.
As of 2016, about 67 percent of Americans had a dental plan in place. If you’re part of the other third that doesn’t, then it may be worth considering. Dental insurance covers preventive care, some minor dental services and specific major dental work. You might think that covering the cost of a standard cleaning on your own would be less expensive, and you might be right. But true preventive care – twice-annual cleanings and yearly X-rays, for instance – goes a long way toward preventing major health problems down the road. By putting dental insurance in place, you’ll save money over time, especially if your dentist discovers a serious problem that requires extensive work or surgery.
You can buy a dental plan on its own no matter how old you are, even if you don’t have health insurance. Major medical policies, including Medicare, usually don’t cover dental care. Most plans follow a 100-80-50 rule, meaning 100 percent coverage for preventive services, 80 percent for minor work, like fillings, and 50 percent for more invasive care, such as crowns or bridges.
About two-thirds of American adults use corrective lenses of some kind. If you’re among them, then vision coverage is essential. But even those who don’t currently wear glasses or struggle with eye problems may benefit from routine checkups. Eye exams can reveal other medical problems, and the older you get, the more frequently you should check in with an ophthalmologist. Vision benefits aren’t usually included in major medical plans, but you can buy them as standalone policies – with or without health insurance – or as part of a bundled package with dental benefits.
Vision coverage includes a number of benefits, including regular screenings for vision and eye health problems, a national network of participating providers, the choice to use any provider and still receive services, low copays for exams, and discounts on glasses or contacts (or a free pair of glasses or contacts depending on your plan allowance). For those with Medicare, which doesn’t include vision benefits, standalone vision policies are a good investment since these plans can be purchased at any age.
In 2013, heart attacks ranked as the fifth most expensive condition treated in a hospital, averaging $20,086 per stay. Heart attacks aren’t the only unexpected medical expense that could affect you or your family. Cancer, paralysis, blindness and other critical illnesses can strike at any time, and the last thing you want to worry about is how to cover your bills while you’re receiving treatment. That’s where critical illness protection comes in.
Sold as a standalone product whether you have major medical insurance or not, critical illness coverage pays out a lump-sum benefit for covered critical illness diagnoses or events. That means that when you get a diagnosis of cancer, for instance, your insurer will pay you the amount specified in the plan. Policies vary, but you may get $10,000 to $50,000 – a maximum lifetime payout – for a single event, such as a heart attack. There are no deductibles to meet, the money you receive isn’t taxable income, and you can use it for anything, from expenses not covered by your insurance to grocery bills, travel and more.
Unintentional injuries account for 21 million medical visits each year, adding up to around $220 billion. Accident is a broad category and can include everything from slipping on the ladder while you’re cleaning the gutters to sustaining burns after a new recipe goes awry in the kitchen. For these and other accidents, there’s accident coverage. Sold as a separate policy to people with major medical insurance, accident coverage pays out benefits to your provider for covered accidents up to a maximum limit per calendar year.
As with any plan type, coverage varies based on the policy you choose. You might receive between $2,500 and $6,500 per person, per accident depending on treatment type and what you’re receiving care for. Accident coverage requires you to pay a deductible before the plan pays out benefits, which could be about $250. Covered accidents will also vary but typically include things like burns, concussions, lacerations (deep cuts) and fractures, and covered benefits include medical treatments related to those accidents, such as physical therapy or outpatient surgery. These plans can help alleviate some of the extra cost associated with accidents, even if you have health insurance.
Hospital spending topped $1 trillion in 2016 and made up about 32 percent of what the U.S. spent on healthcare in total. If you’ve spent any time in a hospital, then you know that costs add up quickly. Even with good health insurance, you may face bills into the thousands for everything from a week-long bout of the flu to complications from surgery. Hospital indemnity coverage, offered as a companion to major medical insurance, can help you cover those unexpected bills.
Hospital indemnity protection pays you a set amount of money for each day that you’re in a hospital. Policies vary, but you might get $500 to $1,000 per day or more. This money is paid to you after you submit a claim. You aren’t restricted to a network of providers, you don’t have to meet a deductible first and you don’t have to use the money for medical bills. A hospital indemnity payout can be used to cover medical bills, your rent, utilities or everyday expenses while you’re out of work and recovering. Best of all, it’s guaranteed renewable until age 65, and you can cover your whole family.
Few people spend time worrying about a devastating injury, one that would keep you out of work for six months or more. But these injuries happen, and they’re not uncommon. And if you’re like many Americans, you might not have the savings to keep your family afloat until you can work again. One survey in 2015 found that about 20 percent of people with health insurance had problems covering medical bills – that figure jumped to 53 percent among the uninsured. Add to this problem the cost of everyday living, from grocery bills to clothes and school expenses for your kids, and you can see why disability insurance makes good financial sense.
Disability insurance, sold alone or as part of bundled benefits packages, gives you peace of mind for the “what if” scenarios of life. What if you get a debilitating illness and can’t work for a year? What if an accident confines you to a wheelchair for six months? Most families don’t have the savings to cover this level of lost income. Disability insurance pays you a set monthly amount – from $500 to $5,000 – that can be used for anything, from mortgage payments to the electric bill. Benefit periods might last one, two or five years, and policies may be guaranteed renewable until age 70 for full-time employees.
If you are offered coverage through an employer, you will most likely stick with that option because you will not be eligible for cost assistance on the Marketplace. Family members who have access to employer coverage will not get cost assistance either. You may lose any contribution your employer makes to your premiums.
You and your family may qualify for an exemption from the mandate if the employer coverage is considered “unaffordable”, which allows you access to more coverage options and special enrollment periods.
If you are eligible for job-based insurance and considering switching to a marketplace plan, qualifying for lower costs based on your income will depend on one of these three conditions:
- The job-based insurance does not pay a minimum of 50 percent of your premium.
- It is unaffordable – costs exceed 9.5 percent of family income for employee only insurance.
- It does not meet the minimum essential requirements, which must be equivalent to a bronze plan sold on the marketplace.
Obamacare/ ACA (Major Medical Health Insurance)
If you missed the 2019 Open Enrollment Period, which ended for almost all states on December 15, 2018, you’ll only be able to get a major medical (Obamacare) plan during the off season if you have a Qualifying Life Event. A couple of examples of a Qualifying Life Event is if you moved to a new ZIP Code, you got married or divorced, had a child, lost your parent’s health insurance coverage or lost your employer health benefits. If a Qualifying Life Event occurs you’ll have 60 days from the date of the event to get new ACA coverage.
Before the Affordable Care Act (ACA), you could buy a health plan at any time in the private individual and family health insurance market. Today insurers have adopted the same enrollment periods as the health insurance marketplaces to encourage people to find coverage sooner, rather than later. The ACA law created new guidelines to help you:
- Keep your current health coverage if you like the plan.
- Allow children under 26 to stay on a parent’s health insurance plan.
- Find affordable insurance coverage through the new Health Insurance Marketplace.
- Cover pre-existing conditions.
- Receive the ten essential health benefits and preventive services
Quick Facts About Obamacare’s Health Insurance Marketplace
- Minimum essential coverage is included in all marketplace coverage, most Major Medical Coverage sold outside the marketplace, Medicare, Medicaid, employer-based coverage, and more. It does not include short-term health insurance.
- To purchase or change plans outside of open enrollment (on or after December 16th for most states) you need to qualify for special enrollment.
- For 2019 coverage, Open Enrollment began on November 1st, 2018 and ends December 15, 2018.
- If you don’t get health insurance coverage during the 2019 Open Enrollment Period, you’ll have to wait a whole year, until November 1, 2019 to enroll.
- If you have access to employer-based coverage, qualify for Medicaid, Medicare, CHIP, or your income is over 400% of the Federal Poverty Level, you will not qualify for premium and out-of-pocket cost assistance through tax credits or subsidies.
- Millions are expected to enroll in a marketplace plan for 2019 because premiums have declined in many states.
- In states that use auto-renew, you may be switched to a different plan or level of cost assistance automatically if you do not make a choice