Former President Bill Clinton made waves recently when he slipped and called the Affordable Care Act (ACA) “the craziest thing in the world.” He complained about premiums skyrocketing and benefits being slashed. This comment made for great intrigue during this hot political season, but it isn’t so amusing for people on the market purchasing health insurance.
A major story in recent months has been the closure of many health insurance carriers, particularly ACA exchange plans, across the country. As critics warned long ago, healthcare reform propelled the insured pool to become older and less healthy, making the market unsustainable for many insurers.
This is very much the case in New Jersey too. Two popular insurers, Health Republic and Oscar, no longer offer healthcare plans in our state — a major blow to the individual health plan market, whether or not you receive ACA subsidies. Another new constraint is that individual market plans no longer cover providers outside New Jersey.
There Are Still Great Options Out There — Plus New Ones
Now — from November 1 through January 31 — is “Open Enrollment,” i.e., the time to enroll in your 2017 health plan.
The good news is that there is still an array of good individual health care options available for you from various reputable carriers. We at Cosmo know these options inside out, and will guide you towards the best one for you.
Even better news is that, for a change, there is one major attractive option that we have added for this year. We found a quality insurer that now offers group-rate coverage with significant savings for a two-person, husband-and-wife group. If husband and wife are partners or work for the same corporation (25+ hrs per week) they can qualify for this affordable coverage — even if there is no one else in the group. Previously, insurers did not offer group coverage for husband and wife alone.
This is a game changer for many couples in business, as individual market options have otherwise worsened. We’ll be happy to tell you how you can take advantage of it!
A Review of ‘Open Enrollment’
“Open Enrollment” is by now almost a household word, but there is still lots of confusion. Here’s a recap of why the next three months are critical for which healthcare you’ll be enrolling in until 2018. It is for your benefit to pay close attention.
During this period, you can enroll in any new plan available for you. By law, health insurance companies may not discriminate based on any health condition. Premium rates are equal for all based on age and the state you live in. Whatever plan you enroll in during this period will be in effect through December 31, 2017. You will not be able to upgrade or switch plans beforehand, no matter how much you’re willing to pay out of pocket.
The only way one can switch plans in 2017, after Open Enrollment concludes, is if one qualifies for a group plan or loses existing health coverage due to a qualifying circumstance, such as a death in the family, divorce, loss of employment or termination of Medicaid coverage.
It is important to note that even though group plans can commence all year round, the current open season can be very helpful for people who are employed or part of another insurance group too. During open season, you can obtain group coverage without many of the year-round requirements, such as excluding a particular percentage of the group from participating in the plan.
In any case, don’t just sit back and swallow a premium increase. There may be better plans for you out there today, with benefits that better suit your needs, a better provider network and/or more competitive premiums.
Don’t Wait Around
When assessing your options for next year there are several important things to keep in mind.
First and foremost, bear in mind that if you earn below 400% of poverty level, you can get significant federal ACA subsidies to pay for your premiums when purchasing a plan on the exchange. But be honest about your earnings. The subsidies are based on the income you project to earn in 2016. If you end up earning more than what you tell the government now, you will need to pay Uncle Sam back next year for the excess he paid you this year. That’s certainly not on your wish list.
Whatever plan you end up choosing, the earlier you begin the process, the better. You will have more time to understand your options and make a wise decision. When you enroll earlier, you will have your ID cards in time and greater peace of mind in every aspect of your coverage. Waiting for the last minute to enroll can give you great headaches as well, such as having to delay your appointment with your physician even if you very much need the visit.
A little time and effort now can make a great difference throughout the next year, both financially and with the quality of your healthcare. Just give Cosmo Insurance Agency a call. We will simplify the process for you!
For more information or for a free, no-obligation quote, please call 201-817-1388 or email [email protected].
By Mark Herschlag
Mark Herschlag is the founder and CEO of Cosmo Insurance Agency, which is based in Ocean County. Cosmo Insurance Agency offers personalized solutions for individuals and businesses looking to obtain health, life, dental, long-term care or disability insurance.
