Everything you need to know to get into the best fitting health insurance plan for 2022!

Health Insurance Marketplace OPEN ENROLLMENT: November 1 – December 15, 2021 

Keep in mind we are in a SPECIAL OPEN ENROLLMENT PERIOD until August 15, 2021 for ACA plans to begin on the first day of the month after enrolling. For example, if you enroll in an ACA plan on June 15, 2021, your plan will start on July 1, 2021.

Most people do not realize that they can enroll in a health insurance plan every day of the year. There are many carriers who offer excellent health insurance plans at a tremendous cost savings to what they would pay for an Affordable Care Act (Obamacare) plan. However, if you want to enroll in a guarantee issue ACA Marketplace plan, you must do it between November 1 and December 15 of this year.

Here are the only two reasons why you should consider an ACA plan:

1) You have a pre-existing medical condition that would limit your access to health insurance unless you are in a guarantee issue plan. For instance, most health insurance carriers who do not participate in “the Marketplace” of plans seen on Healthcare.gov would decline a person if he/she has had cancer at one time or another. Maternity is also typically not available on plans other than ACA. Each carrier has their own restrictions, so if your health is not particularly good, or you have had some health issues in the past, then getting on an ACA plan is probably going to be your best (and perhaps only) option.

2) If you are in good health but qualify for a tax credit from the government (your income falls between 100% and 250% of the federal poverty level) and a subsidy from the government (your income falls between 100% and 400% of the FPL) set by the government each year. Keep in mind that the federal poverty level is based upon the number of people in your household. Therefore for example, if you have 3 people in your household and your neighbor has 5 people in her household, she could earn more money during the year and still get the same or more subsidy than you receive. By agreeing to receive the subsidy from the government to be applied towards the cost of your monthly premiums, you agree to file a form 1095-A on your taxes to reconcile the amount of subsidy received with your “actual earnings” at the end of the year, since the subsidy is provided based upon your “projected income” for the upcoming year. You also agree to let the government know if you have any changes in your household, such as the birth of a child that would affect how much subsidy you are able to receive. Something else to keep in mind when opting for an ACA plan is that your out of pocket expenses, deductible levels, and co-insurance (the amount of the medical bill you are required to pay) are going to be greatest on a SILVER plan. If you qualify for a subsidy, do NOT even consider another “metal” (in Alabama: Bronze and Gold only). Otherwise you will be as the proverbial saying goes, “shooting yourself in the foot.”

One final caution if opting for an ACA plan whether you are getting a subsidy and perhaps also a tax credit or you have pre-existing conditions that would necessitate this choice: The dental and vision options available on the Marketplace are generally NOT the best choice for you in any way. Since neither dental nor vision is subject to most ACA provisions because they are not considered part of the “Essential Health Benefit Packages” it is typically much wiser to choose a dental and/or vision plan off the Marketplace exchange. You might want to keep this in mind: Pediatric dental and vision benefits are part of EHBP’s, so if your child/ren younger than age 19 qualify for the Children’s Health Insurance Program (CHIP), in Alabama known as ALL Kids, their dental and vision would be covered.

Here is why you should consider a Health Insurance plan not on the ACA Marketplace exchange:

If you are in good health but earn MORE than 250% of the federal poverty level so that you no longer qualify for the tax credit, while further reducing your subsidy to a minimal type amount, you will pay far less in monthly premium costs as well as giving you the option to reduce your deductibles from what the plans available on the Marketplace offer. If you aren’t eligible for both the tax credit and subsidy, you won’t be able to get a Silver plan with the lower deductibles, and reduced cost-sharing. This year, deductibles per person are allowed to be as much as $8,150 per person, with a $16,300 family limit. Therefore if you get a Marketplace plan without any government tax credit and subsidy, you could very easily be required to pay OVER $30,000 before your marketplace health insurance plan pays one penny! By designing a health insurance plan around your needs, budget, and lifestyle, you can get far more “bang for the buck” so to speak in a private Health Insurance plan. The private Health Insurance carriers are continuing to enrich their plans, as well as offering benefits that are just not available on the Marketplace. Each plan has its own benefits “package” but typically you will find telemedicine included with NO co-pays, unlike most Marketplace plans. Also, most of these private plans have some kind of “free 3rd party arbitration help” so that if you feel there has been a mistake made or an unfair judgment given as to your portion of the bill, you can reach out to these folks who will help you reach a satisfactory resolution to the situation. In almost all cases, if you get into the right kind of policy, and with my help can avoid the “junk” policies that are available, you will have just as good of health insurance coverage (if not better) and spend far less on your overall healthcare costs!

Whether you need help with getting into an ACA plan for now, or for 2022, or a private health insurance plan, I can help you with both. I am FFM certified, which allows me to help you get into an ACA approved plan. And I am appointed to the best health insurance carriers around these days—which utilize the largest health provider networks in the United States.

Ultimately, selecting the best fit for health insurance for you (and your family) is perhaps the most significant decision you make each year about this time. I understand how important these choices you make are and I want you to have peace of mind that the choices you make now are going to really “work” for you if and when you or your family needs medical attention. Let me design a health insurance plan that’s right for you!