happy family on couch browsing health insurance options on tablet

Getting the Most out of Open Enrollment

With 2020 Open Enrollment period in full swing, families across the country are reviewing their current insurance coverages and seeing what other options may be available to them. Below are a few tips to help you navigate the process.

  1. Learn the Language

Insurance jargon may be enough to make some people’s heads spin but learning just a few key terms could help you pick the best health coverage for you and your family. To make it easy, here are a few words we feel you should know:

  • ACA-compliant” refers to plans that follow all the guidelines and regulations in the Affordable Care Act. These plans are only available during the annual Open Enrollment period or through a Special enrollment period, if you have a qualifying event.
  • Non-ACA plans” also known as short term health plans do not adhere to all of the Affordable Care Act’s guidelines and regulations.
  • Deductible” the amount of money you must pay out of pocket before your insurance kicks in
  • Premium” the amount you pay to your insurance company every month
  • In-network” refers to a provider that has a contract with your insurance provider
  • Out-of-network” refers to a provider that does not have a contract with your insurance provider
  1. Think of the Future

No one can predict the future, but you may be able to take an educated guess as to what the next 12 months could hold. Thinking about the coming year could help you determine how much coverage is right for you and your family. Have you had any health issues in the past year? Are you taking any medications? By examining your current health status and concerns you may be able to narrow down your health insurance plan options.

  1. Utilize Your Resources

Did you know as a benefit of your SPARK membership, you have access to our team of licensed Benefits Counselors? Our Benefits Counselors are experts in their field and are standing by to help you navigate the Open Enrollment process and find the best health insurance for you and your family’s needs.

We’ve been providing health insurance answers and guidance for over 30 years. Be sure to visit the SPARK Health Insurance Marketplace for access to appointment scheduling services, webinar replays, and other informational resources designed to help make the Open Enrollment process as quick and easy as possible.

  1. Know Your Deadlines

Like last year, the annual individual health insurance Open Enrollment period began on November 1 and will run until December 15. For those who enroll in one of these ACA-compliant plans, you can expect an effective date of January 1.

Non-ACA plans typically do not follow the ACA open enrollment period dates and are available in most states year-round.

Ready to make your decision? Visit https://spark.memberbenefits.com/health-insurance/ today to secure ACA-compliant coverage for you and your family in 2020.

Upcoming 2020 Individual Health Insurance Open Enrollment Webinar

Join us for a free webinar on Tuesday, October 29 from 12:00pm-12:30pm EDT, where we’ll review the upcoming 2020 Individual Health Insurance Open Enrollment period and cover topics such as important dates, preparation tips, industry updates, and more! Reserve your spot by registering today. Can’t make it to the webinar? Register anyway and we’ll send you a link to the video replay later that day.

professional woman on phone outside smiling

Knowing Your Options Outside of Open Enrollment

While the annual Open Enrollment period focuses on ACA-compliant individual major medical insurance, there are still other forms of insurance available for potential enrollees.

Knowing Your Options

According to healthinsurance.org, “ACA-compliant coverage refers to a major medical health insurance policy that conforms to the regulations set forth in the Affordable Care Act (Obamacare)…This means they must include coverage for the ten essential benefits with no lifetime or annual benefit maximums, and must adhere to the consumer protections built into the law.”

Unless you qualify for a special enrollment period, you cannot receive ACA-compliant individual health insurance coverage outside of the annual Open Enrollment Period, which typically runs from November 1st until December 15th of each year.

If you missed out on Open Enrollment but still need individual health insurance, you still have a few options available:

    1. COBRA

According to the U.S. Department of Labor, “The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.”

  1. Qualifying Life Event (QLE)

There are certain life circumstances called Qualifying Life Events (QLEs) that can qualify you for a special enrollment period. Special enrollment periods allow you to obtain ACA-compliant health coverage outside of the annual Open Enrollment period for you and your eligible dependents. The most common QLEs pertain to:

  • Loss of health coverage
  • Changes in household
  • Changes in residence

If you find yourself matching any of the above circumstances or feel your unique circumstance should qualify you for a special enrollment period, please contact us and our team will help guide you in the right direction based on your individual needs.

  1. Non-ACA Compliant plans

Non-ACA compliant plans, also referred to as short-term medical plans, have recently become more appealing to a growing number of people due to their lower rates. According to the Henry J Kaiser Family Foundation, “Late last year (2017), President Trump issued an executive order directing the Secretary of Health and Human Services to take steps to expand the availability of short-term health insurance policies, and a proposed regulation to increase the maximum coverage term under such policies was published in February.”

So, what separates the ACA-compliant health plans from the ones that are not? One of the biggest factors being the ACA’s ten essential health benefits. Non-ACA compliant plans do not need to adhere to the numerous rules and regulations laid out in the Affordable Care Act.

To learn more about health insurance and what else the SPARK Health Insurance Marketplace can do for you, please visit https://spark.memberbenefits.com/health-insurance/ today.

business man sitting at a cafe discussing his health options on his cell phone

I Missed Open Enrollment and Need Health Coverage — What Are My Options?

The next official ACA Open Enrollment period isn’t slated to begin until November 1, 2019. But depending on your circumstances, you may not have to wait that long to obtain coverage.

Qualifying Life Events and Special Enrollment Periods

Sometimes our circumstances change, and if they change due to specific events, you and your dependents may be able to secure health insurance through a Special Enrollment Period. When this occurs, it is called a Qualifying Life Event, otherwise referred to as a QLE.

There are several types of Qualifying Life Events that may grant you a Special Enrollment Period. Some of the most common examples include:

  • Loss of health coverage
    • Losing existing health coverage – including job-based, individual, and student plans
    • Losing eligibility for Medicare, Medicaid, or CHIP
    • Turning 26 and losing coverage through a parent’s plan
  • Changes in household size
    • Getting married or divorced
    • Having a baby or adopting a child
    • Death in the family
  • Changes in residence
    • Moving to a different ZIP code or county
    • A student moving to or from the place they attend school
    • A seasonal worker moving to or from the place they both live and work
    • Moving to or from a shelter or other transitional housing
  • Other qualifying events
    • Changes in your income that affect the coverage you qualify for
    • Gaining membership in a federally recognized tribe, or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming a U.S. citizen
    • Leaving incarceration (jail or prison)
    • AmeriCorps members starting or ending their service

Non-ACA Health Plans

Haven’t experienced a QLE but still need health coverage? A non-ACA health plan could be the answer. Also referred to as Short Term Medical Plans, recent legislative changes have loosened the restrictions surrounding these plans and have increased their appeal.

Previously, a Short-Term Medical plan could only provide coverage for up to 90 days. But due to recent regulatory changes, these plans can now be continued for up to a year.  Additionally, in some cases applicants may now renew their plan for up to three years.

Because Short-Term Medical Plans are considered non-ACA health plans, it is worth noting that they may not cover all that an ACA health plan would. For example, applicants could be denied coverage due to a pre-existing medical condition, maternity care may not be covered, and there could be an annual dollar limit on coverage. However, these plans are also typically less expensive than ACA plans and could be a good alternative for individuals seeking more affordable options.

Know Your Options

Do you think you may qualify for a Special Enrollment period? Are you interested in hearing more about non-ACA plans and if they may be the right fit for you? Our Benefits Counselors are always on hand to help answer your questions and guide you in the direction that will make the most sense for your unique needs.

Visit your association website to learn more about the Health Insurance offerings that may be available to you, or schedule an appointment with one of our licensed Benefits Counselors today.

mother with breast cancer smiling and hugging her young daughter

What You Should Know: Home Breast Cancer DNA Tests

In March of this year, ancestry DNA testing giant, 23andMe, announced that they would begin testing user DNA for Breast Cancer genes, more specifically identified as the BRCA1 and BRCA2 genes. While technically able to test for these genes for years, it wasn’t until this past March that the FDA officially signed off on it, therefore, making the 23andMe at-home DNA test, the first FDA-approved direct-to-consumer test to evaluate one’s potential risk for cancer.

What Can Your DNA Reveal

The test is offered as an add-on to 23andMe’s standard ancestry report for a total of $199 and is delivered alongside a variety of other reports designed to tell you if you possess certain genetic markers which may suggest a predisposition to things such as:

  • Macular Degeneration
  • Lung and/or Liver Disease
  • Celiac Disease
  • Hemochromatosis
  • Hereditary Thrombophilia
  • Alzheimer’s Disease
  • Parkinson’s, and many more
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Last Chance to Enroll

Last Chance to Enroll in Individual Health Insurance for 2017

Don’t wait until it’s too late to get your individual health coverage for 2017. Open Enrollment for Individual Health Insurance ends on January 31st. If you haven’t enrolled in a plan by this date, you may be stuck with your current coverage or no coverage for the remainder of the year unless you have a qualifying life event. Schedule an appointment with a licensed benefits counselor or start shopping today to make sure you are covered.

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