Congrats Graduates!

Graduations mark a transition into the “real world” for many young adults. And part of being in the “real world” is having health insurance!

If you are entering the working world, you may be eligible for health insurance through your employer.

But if you don’t get a job right away, you still need health insurance (it’s the law!) and you have a few options:

1 – Remain on Your Parent’s Health Plan

If your parent’s health plan covers children, you can be added to or stay on that plan until age 26 — even if you are married, not living at home, or financially independent from your parents.

2 -Purchase Your Own Health Insurance

You can purchase health insurance in the individual marketplace.

All Affordable Care Act (ACA)-compliant plans cover things like doctor visits, preventive care, immunizations, inpatient hospital stays, prescriptions, etc.

Depending on your income level, you may even be eligible for a subsidy to help you pay for coverage.

Each year, there is a period of open enrollment during which you can purchase coverage for any reason. For 2015 plans, open enrollment ended on February 15, 2015.

Outside the dates of open enrollment, however, you may enroll during a special enrollment period if you experience a qualifying event.

Here are some qualifying events that are pretty common for new graduates:

• Your student health plan ends
• You lose other health insurance when you graduate
• You move to a new area
• You get married or have a baby
• You age off of your parent’s health plan

If you do experience one of these or other qualifying events, get in touch with us at 703-707-8270 right away. You typically have 60 days from the date of the event during which you can buy coverage.

3 – Buy Short-Term Health Insurance

Although we don’t recommend short-term health insurance in general, there are times when it is the best option.

Some things to keep in mind:

• Short-term plans are not subject to the rules of the Affordable Care Act (ACA).  Therefore, they provide less coverage than ACA-compliant plans.  Since they do not meet ACA minimum essential coverage requirements they typically do not cover things like preventive care, immunizations, maternity care, allergies, etc.

• Short-term coverage can be denied for anyone who is sick.

• Pre-existing conditions are usually not covered by short-term policies.

• A short-term policy does not have guaranteed renewal.  This means if you buy, for example, a 60-day plan, the carrier is not required to renew your coverage at the end of 60 days.  If you get sick during those 60 days, your request to renew can be denied.

• If you get sick during your initial policy period and your carrier does permit you to renew, that sickness is now considered a pre-existing condition under your new policy.  Any treatment for that condition will be denied.

• Since they do not meet minimum essential coverage requirements, short-term plans do not satisfy ACA’s individual mandate.  This means if you have a short-term policy, you may still be subjected to a tax penalty under ACA.

Short-term coverage is not ideal, but it is surely better than having no coverage at all.

Virginia Medical Plans Can Help

If you live in Virginia, Maryland, or the District of Columbia, we can help you find the best coverage to meet your needs based on your situation.

If you are a Virginia or DC resident, we can help you enroll in a plan with or without a subsidy. If you live in Maryland, we can help you enroll off-exchange (without a subsidy).

Give us a call at 703-707-8270 or click on the Instant Quote button in the upper right corner of this page to get started.

What is a Qualifying Event and What Should I Do if I Have One?

Note: this post was originally published on May 12, 2014 but has been updated for 2015.

When it comes to health insurance, a qualifying event is a life event that makes you eligible to purchase health insurance outside the dates of open enrollment.  A qualifying event triggers a special enrollment period lasting 30-60 days, depending on the event.  Read more about special enrollment periods.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)

• Relocation to a new state or to an area of your current state where the plans offered are different

• Change in family size (birth/adoption/death of a child)

• Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)

• Certain changes in income

• Expiration of COBRA benefits

Newly added by the Department of Health and Human Services (HHS) and effective April, 2015:

• A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs. You could switch, for example, from single to family coverage during a special enrollment period. HHS is not mandating this change until 2017, but is encouraging exchanges to offer it as soon as possible.

• An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.

• If a court order requires someone to provide health insurance (for example during divorce proceedings), the coverage must be available the first day the court order takes effect, even if that date is outside open enrollment.

• If you have a pre-Affordable Care Act plan which does not run on a calendar year basis, and that coverage terminates outside the dates of open enrollment.

What Should You Do if You Have a Qualifying Event?

If you do have a qualifying event, you must have proof of the event in order to be eligible to purchase a new plan.  When applying for coverage, you will need to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.

If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you will need to purchase coverage on your state’s health insurance exchange (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

But remember, you have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.

Give our office a call at 703-707-8270 and we’d be glad to help.

Buying 2015 Health Insurance Outside of Open Enrollment

A qualifying event opens the door to purchase coverage outside of open enrollment.

Open enrollment for 2015 health insurance has ended.  It ran from November 15, 2014 through February 15, 2015.

Outside those dates, you must have a qualifying event in order to be eligible to purchase Affordable Care Act-compliant coverage which is effective in 2015.

NOTE: Anthem has extended its deadline to purchase off-exchange 2015 coverage until February 28.  Click here for more info.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)
• Relocation to a new state
• Change in family size (birth/adoption/death of a child)
• Loss of minimum essential health coverage (change in employment status, cancellation of current coverage)
• Certain changes in income
• Expiration of COBRA

Qualifying Events Trigger a Special Enrollment Period

A qualifying event triggers a special enrollment period during which you can enroll in a health insurance plan outside of open enrollment.

Most special enrollment periods last 60 days, so be sure to act quickly if you have one of these events.

If You Have a Qualifying Event

If you do have a qualifying event, you must have proof of the event.  When applying for coverage, you will be asked to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.

If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you must purchase coverage on your state’s health insurance exchange in order to collect the subsidy (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

What if You Don’t Have a Qualifying Event?

Absent a qualifying event, most individuals will not be able to purchase Affordable Care Act (ACA)-compliant health insurance coverage for 2015 after February 15*.  Instead, you will need to wait until next year’s open enrollment to buy coverage effective in 2016.

If you are concerned about being uninsured for the remainder of 2015, you may have an option to purchase a temporary policy as a bridge through the end of the year.

Temporary plans offered outside of a special or open enrollment period will not be ACA-compliant.  One critical missing piece will be coverage for pre-existing conditions; they will not be covered.  But you would be covered for any new illness or injury that arises.  Although not ideal, a temporary plan is better than having no coverage at all.

Here are two companies we work with that offer short term, temporary coverage:

• Assurant Health
• UnitedHealth Care

Virginia Medical Plans Can Help

If you have a qualifying event, let us know right away so we can help you find new coverage that will best meet your needs.

Even without a qualifying event, if you do not have health insurance, give us a call.  We may be able to help you at least find a temporary policy to give you peace of mind until 2016.

Give us a call at 703-707-8270.

*Exception — Anthem BC/BS has extended its deadline to purchase off-exchange 2015 plans to February 28, 2015.  Click here for more information.

What is a Qualifying Event and What Should I Do if I Have One?

Note: this post was originally published on May 12, 2014 but has been updated for 2015. What appears here is the updated information, as of March 2015.

When it comes to health insurance, a qualifying event is a life event that makes you eligible to purchase health insurance outside the dates of open enrollment.  A qualifying event triggers a special enrollment period lasting 30-60 days, depending on the event.  Read more about special enrollment periods.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)

• Relocation to a new state or to an area of your current state where the plans offered are different

• Change in family size (birth/adoption/death of a child)

• Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)

• Certain changes in income

• Expiration of COBRA benefits

Newly added by the Department of Health and Human Services (HHS) and effective April, 2015:

• A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs. You could switch, for example, from single to family coverage during a special enrollment period. HHS is not mandating this change until 2017, but is encouraging exchanges to offer it as soon as possible.

• An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.

• If a court order requires someone to provide health insurance (for example during divorce proceedings), the coverage must be available the first day the court order takes effect, even if that date is outside open enrollment.

• If you have a pre-Affordable Care Act plan which does not run on a calendar year basis, and that coverage terminates outside the dates of open enrollment.

What Should You Do if You Have a Qualifying Event?

If you do have a qualifying event, you must have proof of the event in order to be eligible to purchase a new plan.  When applying for coverage, you will need to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.

If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you will need to purchase coverage on your state’s health insurance exchange (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

But remember, you have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.

Give our office a call at 703-707-8270 and we’d be glad to help.