Employers frequently subsidize family health coverage, meaning your spouse’s share may be automatically deducted from their paycheck. Please check with their employer or reach out to our helpline for details.
The Affordable Care Act (ACA) made health insurance more accessible to many by providing subsidies that help to offset monthly premium costs and decrease associated costs such as deductibles, copays, and coinsurance premiums. You can apply any time during the year to see if you qualify – application periods don’t close!
Open Enrollment Period
Open enrollment is a limited window each year when Americans can make changes to their health insurance. It typically runs from November through January in most states and is intended to prevent people from enrolling only when needed, which would strain insurer finances and potentially increase premiums across the board.
At open enrollment, you have an opportunity to sign up or adjust plans for individual marketplace coverage and job-based health insurance, use Medicaid applications and Children’s Health Insurance Program applications online marketplace tool and apply for Medicare Part A/B coverage. Before making a selection whether during open enrollment or out of it, carefully assess all your options to make sure they suit both your healthcare needs and budget.
If you are already insured, typically no action are required during open enrollment periods. If your health and dental plans come from an employer, be sure to ask when their open enrollment periods begin and end as companies often allow employees to add/delete dependents from health, dental and flexible spending accounts during this time.
Applying for Medicaid and the Children’s Health insurance Program are government programs offering health coverage at no cost for low-income families. In order to qualify, certain criteria must be met, including being an American citizen and/or having children eligible for these programs.
Health care markets are ever-evolving, making it essential to stay abreast of developments within them and make wise decisions based on current data. You should keep an eye out for updates to the Affordable Care Act which have varied depending on which state they affect – it might have changed, it might not, etc.
No matter where you reside, the process for changing health insurance plans is similar across states. Simply log into your employer’s benefits portal or the marketplace to review available plans and complete necessary forms; after which, select one that is tailored specifically for you and your family.
Employer-Based Coverage
Employer-sponsored coverage (EPC), also referred to as group health insurance, is one of the primary sources of non-elderly Americans’ health coverage in America.
Recent years have witnessed an exponentially rising cost for employer-sponsored health insurance premiums due to rising healthcare costs, new and more costly technologies, treatments, and drugs – increasing premiums substantially while becoming harder for employers to afford this costly benefit for their workforce. More and more employers are struggling to afford such costly benefits for their workers.
Employers that employ 50 full-time employees or full-time equivalents or more must offer health coverage that satisfies minimum value standards; those failing to offer coverage could face penalties.
Employers typically purchase large-group policies to cover groups of workers at once, like an entire workforce or smaller companies with multiple employees. Some large organizations choose “self-insuring,” or paying their own coverage rather than purchasing from an insurer – which can come with its own set of benefits and rules.
If your employer offers health coverage, the annual open enrollment period must be taken advantage of in order to sign up and select an insurance plan before it ends. Doing this ensures you avoid waiting periods or losing coverage altogether. Your employer may only offer one health plan or several, with premium costs depending on which plan is chosen.
With employer-sponsored health insurance, you may qualify for additional help paying out-of-pocket expenses, like copays and coinsurance premiums, through Cost-Sharing Reduction subsidies available on marketplace/exchange silver level plans. To determine whether you qualify, visit the Affordability Tool.
If your employer does not offer health coverage or their plan does not meet minimum value standards, or does not meet them adequately, Covered California offers marketplace/exchange plans which allow individuals to enroll during open enrollment periods and qualify for financial assistance. In order to enroll successfully on this exchange platform.
Health Insurance Marketplace
The Health Insurance Marketplace is a place for you to shop for health insurance coverage. Operated jointly by your state and the federal governments, it can help if your employer doesn’t offer coverage or you need coverage outside your work if your current coverage doesn’t suffice. Furthermore, premium tax credits may help offset some of the cost; these credits apply only for individuals earning between 100-400% of federal poverty levels.
The Marketplace can also determine your eligibility for free or low-cost coverage through Medicaid, the Essential Plan and Child Health Plus programs. Apply for them by visiting their website and entering your zip code before choosing a plan best suited for you and your family.
Typically, enrolling during the Open Enrollment Period is required; however, certain life events could qualify you for a Special Enrollment Period such as getting married or giving birth; then during this Special Enrollment Period you can make changes to your existing plan or enroll in a new plan.
Register for a Marketplace plan online, by phone, or with paper applications. Additionally, trained Marketplace assisters are available in your community who can assist in the enrollment process – some even speaking your native tongue! – and help find you coverage for preexisting conditions.
To locate a Marketplace helper near you, enter your city, state, and ZIP code here. Alternatively, if you prefer speaking directly with someone instead of typing out your query online, call the 1-800-318-2596 help line instead.
If you are self-employed or don’t have job-based health coverage, the Marketplace allows you to easily compare plans and prices for individual and family health insurance plans. Plus, find out if cost assistance applies and what your monthly payments might look like!
Apply for assistance through a private broker or insurance agent; just be aware of when is best to do this if you miss the deadlines as missing them will prevent cost assistance being granted to you.
Medicaid
You could qualify for free health insurance if you meet certain income and other criteria. Apply either online or by phone during open enrollment period; additionally, the Affordable Care Act offers government subsidies such as premium tax credits and cost-sharing reductions to make health coverage more cost effective.
If you don’t currently have health insurance or your current plan is too costly, or simply looking for more affordable coverage options, the Affordable Care Act’s (ACA’s) Health Insurance Marketplace may offer affordable marketplace plans. Use this website to search and compare plans according to price, benefits, and quality criteria.
Many states have expanded their Medicaid programs to offer free or low-cost health coverage to families, children, pregnant women and elderly individuals. You can apply at any time of year – you might even receive coverage right away!
Although Medicaid is a government program, most states contract with private health insurers to administer it and this explains why you may see the name and logo of a well-known insurer on your Medicaid ID card.
To qualify for Medicaid in your state, you must meet specific income and household size criteria that correspond with its program. Additionally, US citizens or lawfully present individuals must also satisfy immigration status requirements to be eligible. Furthermore, federal contributions vary based on where you reside.
Visit your state’s Department of Health Services or government agency in your area to discover more about what its specific program requires for participation. Some states may ask for proof of citizenship or lawful presence while others might require documentation of your income and other details.
In general, to qualify for benefits in most states you must submit a complete application that fulfills any additional requirements of that particular state. Some of these may include providing valid social security numbers, addresses, phone numbers and bank account data – some states also may request additional documents like birth certificates or marriage licenses as forms of identification if applicable. If you need help applying, reach out to either your state’s assistance line or local community center for help applying.
