Skip to main content

Category: What To Know

I notice short-term policies are for sale outside of the Marketplace and they are cheaper than many other policies. What is a short-term policy?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

As the name implies, a short-term health insurance policy offers coverage for a period of less than 12 months.  Many offer coverage for just 3 to 6 months.  Beyond that term, coverage generally can only be continued if the insurance company agrees.  This is sometimes called a non-guaranteed-renewable policy.  If you’ve made claims since you bought the short-term policy, the insurer can, and likely will refuse to continue coverage once the policy term ends.

In addition, short-term policies do not offer other protections found in Marketplace plans.  For example, short-term policies can exclude coverage of pre-existing conditions.  Short-term policies also typically do not cover essential health benefits such as prescription drugs, mental health care, substance abuse treatment, or maternity care.

What is a grandfathered plan? How do I know if I have one?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same. If you buy coverage on your own and you first purchased your policy prior to March 23, 2010, it may be a grandfathered plan.  If you currently are covered under a non-group policy – whether it is grandfathered or not – you can also explore other qualified plans offered through the Marketplace and, if you prefer, you can switch to a new plan during Open Enrollment. To be eligible for a tax credit to help pay your premium – which will be based on your income – you would have to switch to a plan offered through the Marketplace.  Some group plans offered by employers may also be grandfathered plans. A grandfathered group plan also must have been first established prior to March 23, 2010. To retain grandfather status, the group plan cannot be significantly changed (that is, the employer can’t significantly change covered benefits or cost sharing or the share of the plan premium that you are required to contribute.) Because employer plans tend to change from year to year, most have already lost grandfather status or will lose it over time. Meanwhile, however, grandfathered plans are not required to provide all of the benefits and consumer protections required of other health plans. For example, a grandfathered health plan might not cover preventive health services.  Employers with grandfathered group health plans are allowed to enroll new employees in the grandfathered plan. So even if you first joined a group health plan after March 23, 2010, you should ask about its grandfathered status. Your employer or your insurer must let you know if your health plan is grandfathered.

Do private insurance policies have to be labeled to show whether they are Minimum Essential Coverage?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

All health insurers and employer-sponsored group health plans must provide people with a Summary of Benefits and Coverage, which uses a standard format to outline the benefits, cost-sharing and coverage limits of plans. The Summary of Benefits and Coverage must also say whether the plan meets minimum value and counts as minimum essential coverage.

What kinds of coverage count as Minimum Essential Coverage to satisfy the requirement to have health insurance?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Most people with health coverage today have a plan that will count as minimum essential coverage. The following types of health coverage count as minimum essential coverage:

  • Employer-sponsored group health plans
  • Union plans
  • COBRA coverage
  • Retiree health plans
  • Non-group health insurance that you buy on your own, for example, through the health insurance Marketplace
  • Student health insurance plans
  • Grandfathered health plans
  • Medicare
  • Medicaid
  • The Children’s Health Insurance Program (CHIP)
  • TRICARE (military health coverage)
  • Veterans’ health care programs
  • Peace Corps Volunteer plans

Be aware that outside of the Marketplace, other policies be for sale that may look like health insurance (such as short term individual policies, or policies that only cover cancer.) These kinds of products are sometimes referred to as “excepted benefits.” They do not count as Minimum Essential Coverage.

 

Starting in 2019, there is no tax penalty for people who are not covered by Minimum Essential Coverage.

I was in jail for 4 months awaiting trial and ultimately was exonerated. During that time I was also uninsured. Do I owe a penalty for the months I was in jail?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

There is an exemption for people who are incarcerated but it does not apply to people who were in jail awaiting trial.

However, for 2018, you could also claim a hardship exemption because you experienced circumstances that prevented you from obtaining coverage.  You can claim this exemption directly on your 2018 tax return, by checking the box on Form 1040, when you file next spring.

I didn’t apply for a hardship exemption from the Marketplace during Open Enrollment. Is it too late to apply for a hardship exemption for this year?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

No, you can apply to the Marketplace for a hardship exemption at any time during the year.  Most hardship exemptions will be granted for the month before the hardship, the months of the hardship, and the month after the hardship. You will need to document the timing of the hardship in your application.

In addition, for the 2018 tax year, you can claim a hardship exemption directly on your tax return, by checking the box on Form 1040, without having to apply to the Marketplace.  You won’t be required to submit documentation of the hardship with your tax return, though you should retain any documents for your own records.