Who Qualifies For Obamacare Health Insurance
Since major provisions of the Affordable Care Act came into effect in 2014, all new major medical health insurance plans are now Obamacare plans. Generally speaking, if you dont get health insurance through an employer, you may qualify for health insurance under Obamacare.
More specifically, you may be eligible to buy Obamacare-compliant health insurance coverage for yourself or your family if you meet the following criteria:
- You do not have health coverage through your employer or someone elses employer
- You earn too much money to qualify for Medicaid
- You live in the United States and are:
- A US citizen
- Otherwise legally present in the US
You should know, however, that this doesnt mean you can get Obamacare coverage right now. Obamacare creates specific, limited enrollment opportunities that can vary depending on your personal circumstances. Outside of these enrollment opportunities you generally cannot sign up for Obamacare coverage on your own .
Here Are Some Examples Of Supplemental Health Insurance Plans
There are many different types of supplemental health plans in California, most of which are specific to a particular area of coverage. Often, these plans are purchased on their own, which means you dont need to be on any other medical plan to buy them.
- Dental Health Insurance: Basic health insurance plans cover dental benefits up to 18 years of age. If you are over 18 years of age, you would need to buy stand-alone dental health insurance coverage from an insurance company.
- Short Term Health Insurance: This is a viable insurance plan for people who need coverage for less than six months. For instance, it would be perfect for individuals who are in-between insurance plans or for those who cannot afford regular insurance but would like to have short-term coverage.
- Travel Health Insurance: This is a great plan for anyone traveling out of the United States to another country. It covers illnesses or accidents that happen while you were traveling. The plan period is valid from when you leave your country until you arrive at your destination.
How To Get Health Coverage
You can get health care coverage through:
- A group coverage plan at your job or your spouse or partner’s job
- Your parents’ insurance plan, if you are under age 26
- A plan you purchase on your own directly from a health insurance company or through the Health Insurance Marketplace
- Government programs such as
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A Qualifying Event At Any Time Of The Year Will Likely Allow You To Enroll
If you experience a qualifying event, be prepared to provide proof of it when you enroll. And in most cases, the current rules limit SEP plan changes to plans at the same metal level the person already has.
The state-run exchanges can use their own discretion on this, but in general, if youre enrolling mid-year, be prepared to provide proof of the qualifying event that triggered your special enrollment period, and know that you might not be able to switch to a more robust or less robust plan during your SEP. And understand that in most but not all cases, the current SEP rules allow you to change your coverage but not necessarily go from being uninsured to insured. So you may be asked to provide proof of your prior coverage in addition to proof of the qualifying event.
For example, a permanent move to an area where different health plans are available will only trigger a SEP if you had coverage before the move. The same is true of getting married: In most cases, at least one spouse must have already had coverage in order for the marriage to trigger a SEP.
If youre curious about your eligibility for a special enrollment period, call 436-1566 to discuss your situation with a licensed insurance professional.
Can You Get A Health Plan For Free
Many people pay nothing if they qualify for the Affordable Care Acts premium tax credit subsidy. This tax credit is taken in advance to lower the amount of each monthly health premium you must pay, although it goes straight to the insurer.
You must apply for a plan through the Health Insurance Marketplace to be eligible for the premium tax credit. If your state has its own exchange, check the website to see which tax credits are available.
The amount you receive will depend on the household income that you disclose when you apply. If you make between 100% and 400% of the federal poverty level , you’ll qualify for subsidies on health plans that you can buy through the Health Insurance Marketplace, the federal government’s program for buying ACA plans. If you make over 400% of the FPL, you may qualify for subsidies in 2021 and 2022, thanks to the American Rescue Plan. Even if your income was too high in prior years. you may be eligible for tax credits for 2021 and 2022.
You must file a tax return at the end of the year to reconcile your income with the tax credit you received. You may have to pay back some of the tax credit that lowered your costs if you ended up with more income than you thought you would have when you first applied.
You won’t have to pay back any excess tax credit you received in 2020, because the IRS has waived this rule for just this one tax year.
Rules and costs can vary by state, but this option bears looking into before you settle on any other.
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How Can You Buy With Tax Credits
ACA subsidies, also referred to as Premium Tax Credits, work on a sliding scale to limit your monthly premiums to a fixed percentage of your income if you buy the benchmark plan.The benchmark plan is the second cheapest silver health insurance plan available to you in your area. If the benchmark plan costs more than the fixed percentage of your income, you may qualify for a subsidy in the amount of the difference.You are likely to qualify for a health insurance subsidy if your total household income is between 100% and 400% of the federal poverty line . If you earn 133% or less than the FPL, you are likely to qualify for Medicaid in most states. Some states, like California, have expanded their subsidy program so that those making over 400% of the FPL can qualify for some assistance.Keep in mind that eligibility for the upcoming coverage year is based on the FPL guidelines for the previous year. For example, eligibility for subsidies in the 2020 coverage year is based off 2019 FPL guidelines.
What Are Common Types Of Supplemental Health Insurance
Here is a look at some of the most common types of supplemental health insurance.
Critical Illness Insurance
Typically, critical illness insurance pays out a fixed amount of money if the insured experiences a major health problem, such as a stroke, heart attack, organ failure or cancer. While premiums can be relatively inexpensive, these policies are often very specific as to the health conditions that are eligible for a payout.11
Also known as catastrophic illness insurance, this insurance usually pays out as a lump sum that can range from $1,000 to $100,000, depending on the policy. You can then use the money to cover costs related to the illness, including medical costs not covered in your regular policy as well as things like childcare, travel, groceries, and mortgage payments or rent.
Accident insurance, also known as supplemental accident insurance or personal accident insurance, pays benefits if you experience an accident or injury. Policies will usually exempt injuries sustained due to negligence, acts of God and natural disasters, or during activities deemed risky.12
You can purchase accident policies bundled with other insurance policies or separately. Travel companies also offer specific, short-term accident policies, such as an accident policy when you rent a car.
Accidental Death and Supplemental Accident Plans
Hospital Indemnity Insurance
Adult Dental and Vision Coverage
Childrens Dental and Vision Coverage
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What Does Supplemental Health Insurance Cover
Supplemental plans come in many varieties.3 Heres a look at some of the care that might fall under supplemental insurance coverage:
- Serious illness. Critical illness insurance policies typically pay benefits for events such as heart attack, cancer, organ transplant, coma, renal failure or stroke.
- Accidents. Accident insurance policies vary but may cover injuries like car accidents, trips and falls, or travel accidents. They may also provide benefits in case of paralysis or loss of a limb or eyesight.
- Hospital stays. Policies that cover critical medical procedures pay a lump sum for hospital stays and may offer set benefit payouts for things like emergency room services, ICU treatments, ambulance services, X-rays and lab tests.
- Dental visits. Dental plans typically cover most of the costs of preventive dental care, such as routine annual exams and cleanings. Often, they also cover a percentage of the costs of basic procedures such as fillings as well as major ones, such as periodontal treatments, root canals and crowns.4
- Orthodontics. Certain types of dental insurance will cover part of the cost of braces, although this may be limited to children under the age of 18.
- Eye exams. Typically, vision insurance will cover a significant portion of costs for exams, eyeglasses, corrective lenses and contacts.5 A vision policy may also offer discounts on laser vision correction procedures, such as LASIK.6
Your Enrollment Options
Adult Dental And Vision Coverage
Dental and vision care are generally not included in health plans for adults in the U.S.
Original Medicare doesn’t cover routine dental and vision and most commercial health insurance plans don’t, either.
To get those covered, you can enroll in a separate plan that covers dental and/or vision care. Employers often offer this as a supplemental coverage option for employees, with the employer paying a portion of the premiums.
If you don’t have the option of employer-sponsored dental and vision coverage, you can purchase coverage through the private insurance market.
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What Can You Use Obamacare Subsidies For
You can use Obamacare subsidies only toward the monthly premiums for a qualifying Obamacare-compliant health insurance plan.
Its important to know that not all Obamacare-compliant health insurance plans are eligible for purchase with a subsidy. Though they are offered by a variety of brand-name health insurers in each state, only a subset of Obamacare health insurance plans can be purchased with subsidy dollars.
If youre eligible for Obamacare subsidies, the government-run health insurance marketplace in your state, or a licensed health insurance agent or licensed online broker, may help you enroll in a subsidy-eligible Obamacare plan.
Note that you may not use Obamacare subsidies to purchase short-term health insurance plans, vision or dental insurance plans, accident or critical illness insurance plans, life insurance plans, or anything other than qualifying Obamacare plans.
Dental Plan: The Mouth
What goes on in your mouth can have an effect on your overall health. Regular dental care is especially important for people with diabetes , who are more prone to gum disease. Dental plans typically cover routine teeth cleanings and preventive care, as well as procedures like fillings and extractions.
Peggy, 38, is a married mom living in Raleigh, NC. A front desk agent at a local hotel, she bought dental insurance from her employer even though the family has medical coverage through her husband Jim. Shes glad she did: Peggy cracked a filling on a popcorn kernel and needs a repair. Since she chose a more comprehensive plan, shell pay only a fraction of the cost to get a new filling.
Within a week, a parent in her toddlers play group gives her some news. Experts now recommend that little ones have their first dental appointment by age 1, or shortly after the first baby tooth comes in. Her 2-year-old son is overdue! Peggy is delighted to discover her plan covers her sons visit.
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Can You Switch Health Insurance At Any Time
Open Enrollment Special EnrollmentGenerally, the dates for the Open Enrollment Period are
- : The beginning of the enrollment period.
- : The end of the enrollment period.
However, some states may extended their OEPs. Check out this article to see if your state has a longer OEP than the national requirement.
How Fixed Benefit Coverage Works
Fixed benefit also known as fixed-indemnity coverage pays out pre-determined amounts of money for covered benefits.The above image is an example of what a fixed-indemnity plan may payout for an E.R. visit. Your plan would pay set amounts of money for covered services, which leaves you with the rest. In the case of this example, the amount you would pay out-of-pocket is less than 20% of the total bill.
The above example is how a GAP or a deductible protection plan would work with both a short term health insurance plan.In this example, you have incurred a $50,000 medical bill, and you have a short-term health insurance plan with a $2,500 deductible, a 20% coinsurance, and a $5,000 out-of-pocket maximum.Without the GAP plan, you would have to pay $5,000 toward your deductible and in coinsurance up to your out-of-pocket maximum. However, in this example, with your GAP protection of $5,000, you would not have to pay anything out-of-pocket.GAP insurance works similarly if you have a major medical plan by helping you cover your out-of-pocket costs. Gap insurance may be appealing not only to those with short-term health insurance but to those who have large-deductible major medical plans.
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Does Supplement Health Insurance Cost More
Supplement plans will almost always come at a low price tag, just remember this is an additional cost to your base health insurance. With Medicare you are entitled to parts A and B, while other parts will supplement your base plan at additional costs. The savings you get from a supplemental plan will always come from savings on medical expenses and not premiums
Vision Plan: A Window Into Your Overall Health
Vision plans usually cover routine eye exams and help cover prescription lenses and frames. And like dental care, eye exams can also detect early signs of overall health problems, such as high blood pressure and lupus. Thats why its smart to see an eye doctor if even if you have 20/20 vision.
Cecilia, 27, is single and living in Miami, FL. The copy editor at a local magazine has worn prescription glasses since she was a young girl. She wants to update to a more stylish frame this year and knows that her vision plan gives her an annual frame allowance, as well as a reduction in the cost of prescription lenses. If she wanted to try out contacts, she could use her lens benefits for those instead. Either way, Cecilia will be looking her best and protecting her vision for the long term.
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When Youre Ready To Cancel Your Exchange Plan:
If youre enrolled in a plan through HealthCare.gov, you can follow these directions for canceling your exchange plan so you can transition to Medicare. Or you can remove only yourself from the policy if you have other family members who need to stay on the exchange plan.
If youre in a state with a state-run exchange, youll need to follow the steps outlined by your exchange. Regardless of what state youre in, if in doubt, ask for help. Contact the exchange call center or your broker if you have one. Document the call and keep a record of your cancellation request.
Canceling your exchange coverage to switch to Medicare should be relatively simple, but we have seen cases where cancellation requests werent transmitted to the carrier in a timely manner. For that reason, it may be wise to switch from bank draft to paper billing prior to submitting your cancellation request.
That way, if something goes wrong when the cancellation request is being processed, you wont end up with premiums being auto-drafted from your bank account after your coverage was supposed to be terminated.
Why Get Supplemental Health Insurance
Supplemental health insurance is a good choice for seniors who need better coverage than Original Medicare offers or the odd individual or family who has chosen a plan but finds buying additional benefits is cheaper than changing their plan, or other financially sound reasons like having a family that can benefit from vision and dental coverage.
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Supplemental Health Insurance Explained In Less Than 4 Minutes
Having supplemental health insurance in place can help you pay for healthcare costs that aren’t always covered by traditional health plans. Some cover certain events, such as hospital stays or disability. Others cover certain health conditions like cancer.
Learn more about these plans and how they work.
Canceling Your Marketplace Plan When You Become Eligible For Medicare
In most cases, if you have a Marketplace plan when you become eligible for Medicare, youll want to end your Marketplace coverage.
Don’t end your Marketplace plan until you know for sure when your new coverage starts. Once you end Marketplace coverage, you cant re-enroll until the next annual Open Enrollment Period .
Your Medicare coverage start date depends on your situation.
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