You need health insurance and you must have it immediately. Not Next week. Not tomorrow. But right now! What do you do, who do you call and how much will it cost? We’ll try to give you the best advice on how to obtain healthcare as quickly as possible for the cheapest (or no) premium. There are many affordable policies available from top-rated companies. During Open Enrollment periods, and after they have expired, it is possible to quickly get quality medical coverage.
We’ll assume that you are not presently covered under any type of individual, employer or state-sponsored plan. Let’s also assume that you are not able to reinstate a previously-canceled policy, you’re not eligible for an SEP (Special Enrollment Period), and you are not waiting for coverage to begin through your job within the next 30 days. And of course, we’ll base all of our recommendations with the assumption you live here in the US.
Temporary health insurance plans are cheap, and often issued either instantaneously, within hours, or during the first day the application is taken. Most companies have this specific policy in their portfolio and it’s a popular option. But pre-existing condition claims will not be paid. Also, since temporary contracts are “non-compliant” (they do not contain all 10 required essential health benefits required for Marketplace plans), you may be liable for the Obamacare tax, which is currently as much as 2% of your household income.
If you need a policy quickly, this type of benefit is very appropriate and many major carriers (Blue Cross, UnitedHealthcare, Assurant) offer plans. A typical application can be completed online in less than 20 minutes. Height/weight typically is not used in the underwriting process.
How cheap is short-term coverage? For instance, in the Indianapolis area, a 40-year old can purchase coverage with HCC for about $54 per month. The rate reduces to about $43 for a 30 year-old. Family temporary policies are also very inexpensive. A Family of three (male and female age 30 plus one child) will pay only $114 per month with a high deductible, and about $130 with a lower deductible.
It is important to understand that prices will not be the same in all areas of the country, and your age will greatly determine the rate. Obviously, an older individual or family will increase the premium. And with most carriers, if you have smoked within the last 12 months, there will be an increase, although typically, it is not a significant rise. If you start smoking after the policy begins, it will not impact your rate or benefits.
Are you eligible for Medicaid? If you are, you can apply and have coverage effective three months retroactive to the application date (assuming you would have qualified three months ago). Of course, you must be a US citizen and qualify for the standard residency and immigration requirements. Coverage is very comprehensive, including office visits, prescriptions, inpatient and outpatient surgery, maternity, ER, and other common benefits.
Medicaid Expansion is occurring in many states, which increases the number of eligible applicants. Here’s how it works: The Federal Poverty Level threshold is increased from 100% of household income to 133% (which becomes 138%). This results in more families able to take advantage of low (or no) premiums for their personal healthcare needs. However, if your income substantially increases, you may need to switch to a subsidized Marketplace plan.
Disability and financial resources are not factored into the calculation. About 30 states have either expanded benefits already, or are in the process of making the change. More states are expected to consider revisions in their eligibility guidelines in 2016.
As mentioned, the important factor is the minimum federal eligibility level of the FPL. That is, if you are at or below the level, you may be eligible for Medicaid. For a single person, if you make less than $11,6,70, you qualify. For a family of three, the amount is $19,790. For a family of five, the amount is $27,910 and for a family of six, the eligibility amount is $31,970.
In 2014, the “expansion” began. Thus, a single person could be eligible at about $16,243 while a family of three could earn up to $27,724 and a family of five could earn up to $39,206. In some states, you did not have to wait until 2014 because of recent expansion.
CHIP (Children’s Health Insurance Program) is also offered to children in families that can not afford to buy private medical coverage but also earn too much money to qualify for Medicaid. Each state gets matching dollars from the federal government to provide benefits. Benefits vary by state but this program is a great cheap option for your children if you qualify.
State And Federal Health Insurance Exchanges And Marketplaces
In October of 2013, several states began to operate (most with the help of the federal government) their own Exchange (Marketplace) that offered healthcare to its residents. The majority of states (about 37) allowed the Federal Government to take over the operation, at their expense, of course.
However, consumers would continue to be able to purchase coverage through brokers, and of course our website to ensure they were receiving the best pricing. The .gov website also became available for persons that lived in states that did not set up their own Exchange.
NOTE: As of 2015, applicants overwhelmingly prefer consumer websites (like ours) instead of applying through the .gov website. Ease of enrollment, time saved (it only takes about 10 minutes) and free unbiased expert advice regarding subsidy calculations, makes a big difference. Also, most persons applying for a policy prefer corresponding (email, phone etc…) with the same person, instead of “starting all over” with each phone call.
If you need healthcare coverage now, Open Enrollments are available beginning in November of each year and continuing through February. During this period of time, you can apply for medical coverage and can not be denied because of any current or past medical condition. The exact Open Enrollment dates can change each year. For example, in 2015, the OE period was from November 15th to February 15th. In 2016, the OE period begins on November 1st and ends on January 31st.
Pre-Existing Conditions Covered
For example, if you were treated for cancer earlier in the year, or you are an insulin-dependent diabetic with many other existing conditions, you will qualify for a policy. And you will be able to choose from multiple top-rated companies. Each state has different participating carriers including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Humana, and several other companies.
Additionally, you may be eligible for a federal tax subsidy that could pay a substantial portion of your premium on an individual or family plan. The Federal Poverty Level guidelines are used to determine your eligibility and amount of premium reduction you will receive.
Of course, COBRA will only help if you are eligible for benefits. There is no medical underwriting so your acceptance is guaranteed. If you have lost your coverage, and are eligible for COBRA, you can obtain a policy quickly and avoid any lapse. Usually, companies with 20 employees (or more) will offer this option.
However…the rate is very high. Except for rare exceptions, it could be very cost-prohibitive. But if you need immediate treatment for a sickness, illness or injury, you can utilize this contract and keep it until you qualify for a cheaper health insurance plan. For example, if your surgery and total hospital bill is going to cost $50,000, it is certainly worthwhile to pay two months of COBRA, even if the premium is $1,500 per month.
You can apply for a new plan while your COBRA benefits are in effect. But you should not terminate coverage without consulting with us or an experienced broker that will understand your options.
If you’re age 65 or older, a US citizen, and have lived here for at least five years, you may be eligible for Medicare benefits (assuming you also meet the employment criteria). There is no cost to receive basic benefits and enrolling is a fairly simple process. Although the benefits are fairly comprehensive, there are some gaps in coverage.
A Medigap plan (Medicare Supplement) can be considered, especially during an Open Enrollment period. Your acceptance would be guaranteed and there are more than a dozen different policies available. Since there are variations in benefits, premiums will be different for each option. Covering the Part A and Part B deductibles would insulate you against potential large bills n the future in the event of a sickness or injury.
A Medicare Advantage plan will cost the least. However, their continued availability is questionable. Often premiums are less than $30 per month since the insurers provide basic Medicare and supplement benefits in one contract. These specific types of policies are not available in all areas and are not offered by all companies.
You need health insurance coverage now. It is possible to secure a policy from may reputable sources. Often, the rate will be quite affordable and benefits are available for all family members.
April 2015 – Although Open Enrollment has ended, the Department of Health and Human Services has offered consumers a one-time special exception if you did not have qualified coverage in 2014 and were unaware that the most recent Open Enrollment ended on February 15th (2015). Consumers can pay their tax (fee) for last year and purchase qualified coverage before April 30th without incurring any fees for this year. Oddly, you still qualify if the 2014 special tax was not paid.