February 27, 2024
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What to Know About Individual Health Insurance: Open Enrollment 2024

“Open Enrollment” has become a common term for many households, yet there remains a significant amount of uncertainty, particularly this year due to numerous adjustments. Here’s an overview of why the upcoming two months are pivotal for your healthcare selection for 2024.

Individual health coverage refers to health insurance that you can secure for yourself or your entire family. Such coverages are also termed private health policies. Open Enrollment designates the annual window when individuals and families can register for a health insurance package. During this phase, one can change their current plan, include family members, or seek financial assistance. Typically, Open Enrollment spans from November 1st to December 15th in most regions. However, for New Jersey residents, the final date extends to January 31st.

Don’t get confused with Medicare open enrollment which begins October 15th and ends December 7th. This is for those of you who are 65+ and are looking to get started with your Medicare coverage. It’s crucial not to overlook this timeframe; outside of it, changing or enhancing your plan is only permissible if a specific qualifying circumstance arises.

 

Get Covered NJ – New Marketplace

Great news for New Jersey residents! The state features a trusted marketplace, Get Covered NJ. Cosmo remains your go-to local guide for navigating Get Covered NJ. A plethora of quality individual healthcare plans, offered by trusted carriers, awaits you. Our team at Cosmo is well-versed with these options and is committed to steering you towards the one that best suits your needs.

As of 2024, remember that this platform remains the sole portal where you can seek financial assistance (subsidy) to decrease your monthly health insurance premiums. Subsidy eligibility hinges on the household income of the applicant.

 

Medicare Open Enrollment

Starting October 15th, seniors who are 65+ will be eligible for Medicare! As mentioned, this period ends on December 7th and you can apply for Medicare Prescription Plans and Medicare Advantage Plans, but Medicare Supplement Plans can only be acquired during eligibility periods. Make sure to not miss this crucial time!

 

Requirements:

Age: You must be 65 or older. However, certain younger individuals with disabilities or specific conditions like ESRD or ALS can also qualify.

Citizenship: You or your spouse should have worked long enough in the U.S. to be eligible for Social Security or Railroad Retirement benefits, which typically means at least 10 years (or 40 quarters). Additionally, you must be a U.S. citizen or a permanent legal resident.

Medical Condition: If you’re under 65, you can qualify if:

You’ve been receiving Social Security Disability Insurance (SSDI) for more than 24 months.

You have ESRD and require dialysis or a transplant.

You have ALS, commonly known as Lou Gehrig’s disease.

 

Steps to Enroll in Medicare:

Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday month, includes your birthday month, and lasts for three months after. It’s advisable to enroll during this period to avoid potential penalties.

Visit Social Security: You can enroll in Medicare by visiting the local Social Security office, calling Social Security at 1-800-772-1213, or if you worked for a railroad, the Railroad Retirement Board at 1-877-772-5772. You can also enroll online at the official Social Security website.

Automatic Enrollment: If you’re already receiving Social Security or Railroad Retirement Board benefits, you’ll be automatically enrolled in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) on the first day of the month you turn 65.

Manual Enrollment: If you aren’t receiving Social Security or Railroad Retirement benefits, you’ll need to sign up manually during your Initial Enrollment Period.

Medicare Part C & D: If you want to enroll in Medicare Advantage (Part C) or Prescription Drug Plan (Part D), you’ll need to do so separately through a private insurance company. The Medicare Plan Finder can help you compare and choose plans.

Special Enrollment Periods (SEPs): If you missed your Initial Enrollment Period, you might qualify for a Special Enrollment Period if you or your spouse are still working and have group health coverage. The SEP allows you to enroll in Medicare without a penalty for a certain period after your group health coverage ends.

General Enrollment Period: If you missed both the Initial and any Special Enrollment Periods, you can sign up between January 1 and March 31 each year, but you might face penalties, and your coverage will not start until July 1.

Review Annually: Each year, during the Annual Election Period (October 15 to December 7), you can review your coverage and make changes if necessary. This is especially important if you have Medicare Advantage or a Part D prescription plan.

Remember, it’s important to evaluate your needs, understand the different parts of Medicare, and choose the coverage that’s right for you. If you have questions or need assistance, consulting with a Medicare counselor or using resources like the State Health Insurance Assistance Program (SHIP) can be helpful.

 

What Information Is Needed to Enroll in a Health Insurance Plan

Cosmo offers a secure method for health insurance enrollment this year, available both online and via phone.

Required details: Name, social security number, date of birth, address, and email.

Details on household members and earnings are needed if you intend to seek premium subsidies. Verification can be done using recent pay slips, W2s, or your latest tax return.

Provide payment details for your insurance premium charges.

Ensure you have your doctors’ names and zip codes to verify their affiliation with your chosen health plan.

Compile a list of medications for all policy beneficiaries to determine the most suitable coverage for necessary medications.

If you’re above 30 and wish to opt for a catastrophic plan, a hardship exemption is mandatory.

 

Special Enrollment Period –
Qualifying Events

We often get calls from clients year-round thinking they can acquire health insurance without a qualifying event. Unfortunately, this is not the case and it is not possible to acquire health insurance no matter the case. Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can either modify your current plan or enroll in a new one. There are a few requirements that allow you to be eligible for special enrollment. They include: Losing your previous health plan, moving to a different state, getting married, giving birth, or adopting a child. You are eligible for the special enrollment for up to 60 days after the event, and you must wait until the next Open Enrollment if you don’t enroll in the specified time period.

 

Events That Qualify:

Loss of coverage

Gaining/becoming dependent

Gaining access to new plans due to a permanent move to NJ

Recently married or separated/divorced

Loss of eligibility for APTC or CSR

Medicaid/NJ Family Care denial

Experiencing domestic violence or the desertion of spouse and offspring

 

Bottom Line

There are two dates that your health insurance plan can take effect, either January 1st, 2024, or February 1st, 2024. For your insurance to take effect on January 1st you would have to enroll by December 31st, 2023, and to be effective on February 1st you need to enroll by January 31st, 2024.

Plans and rates change each year, so you could be saving money. Fortunately, rates should be increasing by less than 10% this year. Make sure you compare plans during open enrollment. A little time and effort now can make a great difference throughout the next year, both financially and with your healthcare quality. Just give Cosmo Insurance Agency a call. We will simplify the process for you!


Mark Herschlag is 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. For more information or for a free, no-obligation quote, please call (201) 817-1388 or email [email protected].

 

Disclaimer: we do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. All the information provided in this article is not advice and is for informational purposes only. Please consult a licensed insurance broker such as Mark Herschlag for any accurate and additional information.

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