Live In One State And Want To Sell Insurance In Another What You Need To Know About Non
If youre an insurance agent or customer service rep in the insurance industry, you probably know you need to be licensed to sell or even discuss insurance in the state where you live. But, what if you live in one state and work in another? This is a common scenario for people who live near a state border. In this case, youll need both a resident insurance license and a non-resident insurance license.
If you plan to work in another state, follow these steps to ensure you have covered all your bases.
Choosing A Health Insurance Plan
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
Protect Consumers From Subpar Health Plans And Problematic Web
In recent years, the federal government has put consumers at risk by expanding the availability of subpar health coverage and expanding alternative direct enrollment pathways for insurers and brokers without adequate protections.
Subpar plans include so-called short-term health plans, which a Trump Administration rule allows to last up to one year or longer. These plans are exempt from ACA standards and consumer protections, meaning that they can medically underwrite applicants, exclude pre-existing conditions from coverage, and do not include all the ACAs essential health benefits. Subpar plans also include association health plans. A Trump Administration rule allows these plans to offer coverage to individuals and small businesses that is exempt from many ACA standards.
All states have the authority to block or limit subpar plans, and its especially important that states transitioning to an SBM use the opportunity to assert their authority over their markets and protect consumers. Tightening the rules for health coverage markets outside the marketplace would enable any policy advances the state makes to reach more people, while also ensuring that SBM outreach and marketing efforts dont have to compete with misleading and distracting marketing by the sellers of subpar plans. As a state seeks to boost enrollment in health coverage, it must avoid losing people to subpar plans that will leave them with high costs if they get sick.
Issues to Consider: Consumer Protection
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Use The Shift To An Sbm To Achieve Broader Policy Changes
A states decision to set up its own marketplace creates an opportunity for more significant policy changes. In particular, operating an SBM makes it easier for a state to provide state-funded subsidies to supplement those the federal government already provides to help people afford marketplace plans. States that rely on the FFM have no way to seamlessly integrate state-funded subsidies with federal premium tax credits. If a state is willing to invest in a supplemental state tax credit, this is a good reason to make the transition to an SBM.
Several states with SBMs have moved or are considering moving in this direction:
- Massachusetts has long provided sizable subsidies to people with incomes up to 300 percent of the federal poverty level. For example, people with incomes below 150 percent of poverty are guaranteed a $0 premium plan option with low out-of-pocket costs, compared to premiums of $48 to $63 per month for benchmark coverage in other states.
- Vermont provides supplemental premium and cost-sharing assistance to people with incomes between up to 300 percent of poverty.
- California provides state subsidies, beginning in 2020, for people with incomes between 400 and 600 percent of poverty and supplemental subsidies for people with incomes between 200 and 400 percent of poverty.
- Marylands exchange is studying boosting subsidies for younger people, with the goals of reducing uninsurance among this group and improving the risk profile of its individual market.
Health Coverage For People With Disabilities
If you have a disability, you have three options for health coverage through the government.
Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.
Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.
Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .
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Look Into Group Insurance
Everything is better as a group. And you may be able to get health insurance at the lowest cost through a group rate.
Insurance companies dont mind offering lower rates to groups, because it allows them to get many customers at once while spreading risk. Most group plans are employer-sponsored.
However, you may be able to get group insurance through collectives of freelancers, professional and trade organizations. Two examples are the such Screen Actors Guild and Freelancers Union.
Organizations for retired people, such as AARP, are another option.
If you are self-employed, you may be eligible to get small group insurance in 17 states.
Healthcare.gov also features the Small Business Health Options Program that allows the self-employed to get health insurance.
Employers with less than 50 employers can contribute to a Health Reimbursement Account for employers that have a plan through Healthcare.gov.
What Interns Need To Know About Health Insurance
This article was written by Kaleigh Steinorth of PolicyGenius.
A few weeks ago I was quickly preparing to make the big move up to New York City from my hometown in suburban Florida. While I was finding housing, packing up all my belongings and preparing for my internship, I can’t say health insurance ever crossed my mind. In fact, I had never actually thought about my health insurance. Because I have always been covered by my parent’s plan, I was under the impression I could ride that out until I had a full-time job that provided health insurance, or until I turned 26, whichever came first .
Thinking about your health insurance might not be on your insurance to-do list as you get ready for an internship. But if you’re under 26, still covered by your parents’ health insurance and planning on moving to a different state soon, it probably should be. Even though the Affordable Care Act allows individuals under the age of 26 to stay on their parents’ health insurance plans, moving out of state could force the young adult off that plan. I discovered this because my mom’s employer was changing insurance providers, and while reviewing who would be covered on the plan, she found out that Florida Blue wouldn’t cover me after my move.
If you’re a young person on your parents’ health insurance plan about to move to another state, here are the steps you should take to make sure you’re covered:
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Coverage Through An Aca Exchange
You probably wont be able to carry a healthcare insurance exchange or marketplace plan to your new state. In addition, any tax credits you are receiving are likely to be different where youre headed, especially if your income level is expected to change. Also, make sure to alert your current exchange-based provider so you dont pay for coverage after youve moved. You simply need to research the available plans, which you can certainly start doing before you move.
Can You Put Someone On Your Health Insurance Who Is Not A Family Member
One of the most difficult questions that human resources representatives have to answer is who can an employee cover on their health insurance. Once you get past the spouse and children, the laws are no longer as cut-and-dry as they used to be about who can and cannot be covered. In most cases, it depends on the laws of your state and who the state recognizes as a family member.
In most states, stepchildren do qualify as family members who can be covered under a familys health insurance plan. This applies regardless as to whether or not the stepfather has adopted the children or not.
If a man gets a woman pregnant but does not marry her or live with her, then the man can still cover his child on his health insurance. This is a commonly held practice in all of the 50 states.
Common Law Marriage
If you live in a state that recognizes common law marriage and your marriage qualifies under the state guidelines, then you should be able to legally cover your common law spouse on your health insurance. If your state does not recognize common law relationships, then you probably wont be able to cover your partner.
The same situation arises for same-sex unions. If same-sex unions are legal and recognized in your state, then you should be able to cover your spouse under your health insurance. If your state used to recognize same-sex unions but no longer does, then you may be out of luck.
Friends And Other Relatives
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How Family Physicians Are Set
The majority of Canadian citizens and permanent residents have a family physician. They consult their physicians for annual physical exams and ongoing healthcare management. Family physicians order tests, like blood work and X-rays, and refer patients to specialists.
Family physicians may operate out of a small office as solo practitioners. They may also form small collectives where they take turns covering after-hours drop-in services. They might also have a nurse or phlebotomist on staff.
In some areas, the family physician is also a nurse practitioner. They are specially trained nurses who take on many of the duties of a primary care physician. Nurse practitioners based in rural areas may have a rotating schedule where they cover care in communities separated by hundreds of miles. Meanwhile, those in urban areas may be part of a larger clinic that does more than just primary care by including community services like breastfeeding support groups and nutrition services.
Obamacare Faq: What Happens If I Travel
Editors note: For people buying on the individual market who want health insurance starting Jan. 1, the deadline to sign up is Monday, Dec. 23. We are running one post a day with questions and answers on the Affordable Care Act and Covered California until that deadline. Readers can also consult KQEDs Obamacare Guide, written specifically for Californians.
About 130,000 Americans pick up and move somewhere else every single day, the U.S. Census Bureau estimates. And guess who are among the most mobile? We itchy Californians.
Perhaps youre wondering what moving around has to do with Obamacare. Quite a lot, actually.
Your health plan options and prices vary by geography, and the Golden State is divided into 19 regions. Los Angeles is so large that it accounts for two regions, and that doesnt even include the Inland Empire or Orange County.
Today, Ill tell you what happens to your coverage when you travel or move, and whether youll be able to see a doctor when youre in Boise, Berlin or even Berkeley.
Q: I am considering enrolling in one of the Covered California plans. How will my coverage work if I am traveling out of state or out of the country and need medical care?
Im adding one other part to Suellens question: What happens when traveling within California?
When youre traveling outside of California, your insurer doesnt matter: You are only eligible to have emergency and urgent medical services covered.
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How To Enroll And Get Answers To Your Questions
You can learn more about and apply for ACA health care coverage in several ways.
Visit HealthCare.gov to apply for benefits through the ACA Health Insurance Marketplace or you’ll be directed to your state’s health insurance marketplace website. vary by state.
Find a local center to apply or ask questions in person.
Download an application form to apply by mail
Find the answers to common ACA questions about submitting documents, getting and changing coverage, your total costs for health care, tax options, and more.
How Long Do Immigrants Have To Wait Before They’re Eligible For Medicare
If youre a U.S. citizen or have been a lawfully present U.S. resident for more than five years, you can enroll in Medicare if youre at least 65 years old or qualify for coverage due to a long-term disability. People who have paid into the Medicare system via payroll taxes their own or a spouses dont have to pay a premium for Part A. This encompasses the vast majority of Americans, although theres also an option for people to purchase Medicare Part A if the enrollee doesnt have enough work history to qualify for premium-free Medicare Part A.
But people who have not been in the U.S. for five years are not eligible to enroll in Medicare. Obviously, your grandmother hasnt been paying Medicare payroll taxes in the U.S., which means she wont be eligible for premium-free Medicare Part A. But federal regulations stipulate that she needs to have been lawfully admitted for permanent residence and have resided continually in the country for five years before shes eligible to enroll even with premiums.
But the details in Question A.9 are important here too: If she opts to keep her individual market coverage even after she has the opportunity to buy into Medicare , she would then be subject to the late enrollment penalties if she ever decides to enroll in Medicare at a later date. And she would also be limited to enrolling only during the general enrollment period , with coverage effective in July.
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Private Vs Public Insurance In Canada
As previously stated, medical insurance plans in Canada are publicly funded and privately delivered. Canadians can choose any primary caregiver they want as their visits are billed directly to the government.
Specialist visits are arranged by primary caregivers. They take place both in private offices and public facilities like hospitals and clinics.
Hospitals are almost always not-for-profit. However, non-essential services like cosmetic surgery are provided in private, for-profit centers.
Healthcare programs vary significantly from one city to the other. They reflect local concerns, city council spending priorities, and changing demographics.
Municipal public health programs generally are not considered when Canadians discuss their healthcare system. While they are thought of more as municipal services, they still make important contributions to Canadiansâ health and quality of life.
Private health insurance plans in Canada are typically for-profit programs administered by private companies. You will pay out of pocket for these plans, and they can become quite expensive.
One of the benefits of private insurance in Canada is that you will get greater access to a wider range of Canadian hospitals and doctors. Waiting periods are shorter in many cases, especially for more minor illnesses or procedures.
Shopping For Individual Insurance
Shopping for health insurance can seem overwhelming. Think about what is important to you. Start by asking these questions:
What are the costs?
- How much are the monthly premiums?
- Is there a deductible?
- How much are the co-pays and/or co-insurance?
- What is the plan’s out-of-pocket maximum ?
Which doctors and other providers can I see?
- Is there a network? How large is it?
- Can I see any provider in the network?
- Is my current doctor in the network? If I need to choose a new doctor, are there doctors in my area accepting new patients?
- Will I need a referral from my doctor to see a specialist?
- Does the plan have hospitals and pharmacies near me?
- Do I need pre-approval from the plan for certain services?
- If I travel often, what kind of care can I get away from home?
What are the covered benefits?
- What services does the plan pay for? What is not covered? Are the services that I need covered?
How much will I need to pay for my prescriptions?
- Are there any limits on the number of visits for some kinds of care?
What is the quality?
- The California Department of Insurance can tell you how a company ranks in complaints. You can find out how long it takes to reach a real person when you call the company and how many complaints the company gets. We have a PPO Report Card with quality information about PPOs. Call 1-800-927-4357 or go to www.insurance.ca.gov.
- The California Office of the Patient Advocate has information on health insurance and provider quality, at www.opa.ca.gov.
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