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What health plans are offered through the Marketplace?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

All health plans offered through the Marketplace must meet the requirements of “qualified health plans.” This means they will cover essential health benefits, limit the amount of cost sharing (such as deductibles and co-pays) for covered benefits, and satisfy all other consumer protections required under the Affordable Care Act.

Health plans may vary somewhat in the benefits they cover. Health plans also will vary based on the level of cost sharing required. Plans will be labeled Bronze, Silver, Gold, and Platinum to indicate the overall amount of cost sharing they require. Bronze plans will have the highest deductibles and other cost sharing, while Platinum plans will have the lowest. Health plans will also vary based on the networks of hospitals and other health care providers they offer. Some plans will require you to get all non-emergency care in-network, while others will provide some coverage when you receive out-of-network care.

What happens if I want to quit a Marketplace health plan during the year?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

It is important that you contact both the Marketplace and the health plan and let them know you no longer need coverage.  In HealthCare.gov states, you can log into your Marketplace account, select the “terminate coverage” option, and enter the required information.

If you have a family policy and want to remove one person from the policy but keep coverage in effect for others, in HealthCare.gov states, log in to your Marketplace account, select the “reporting a life change” option, and enter the required information.

If you have questions about these changes, contact one of the agents here at Hummingbird. We will be happy to assist you in updating your information through Healthcare.gov.

Making these changes through your Marketplace account will create a written record that you tried to end coverage.

Do not simply stop paying the premium for your Marketplace health plan as a way to terminate coverage.  Nonpayment will eventually cause your coverage to end, but in the future, if you try to enroll in coverage again with that insurer, you might be prevented from doing so until you repay the missed premium.

I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment opportunity that lasts for 60 days. You can apply for Marketplace health plans and (depending on your income) for premium tax credits and cost sharing reductions during that period. If you enroll in COBRA coverage through your former employer, however, you will need to wait to the next Marketplace Open Enrollment period if you want to switch to a Marketplace plan.

I have COBRA and it’s too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

During Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment opportunity.  

Can I buy or change private health plan coverage outside of Open Enrollment?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

In general, you can have a special enrollment opportunity to sign up for private, non-group coverage during the year, other than during Open Enrollment period, if you have a qualifying life event. Events that trigger a special enrollment period (SEP) are:

  • Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity
  • Marriage (limitations apply)
  • Gaining a dependent (for example, if you give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity in most states
  • Loss of coverage due to loss of dependent status (for example, because of divorce, legal separation, death, or “aging off” a parents’ plan when you turn 26)
  • A permanent move to another state or within a state if you move outside of your health plan service area (limitations apply)
  • Exhaustion of COBRA coverage
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program
  • For people enrolled in a Marketplace plan, income increases or decreases enough to change your eligibility for subsidies
  • Change in immigration status
  • Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.

Note that some triggering events will only qualify you for a SEP in the health insurance Marketplace; they do not apply in the outside market. For example, if you gain citizenship or lawfully present status, the Marketplace must provide you with a special enrollment opportunity.

When you experience a qualifying event, your SEP will last 60 days from the date of that triggering event.  If you can foresee loss of other coverage (for example, you know the date when you will graduate and lose student health coverage) you can ask the Marketplace for a SEP up to 60 days in advance so new coverage will take effect right after your old coverage runs out.  However, in HealthCare.gov states, you cannot ask for an advance SEP if you anticipate coverage loss due to a permanent move.

Can I buy a plan in the Marketplace if I don’t have a green card?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

If you are not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S., you are not eligible to buy a plan on the health insurance Marketplace. However, you can shop for health insurance outside of the Marketplace in the non-group market. Insurers outside of the Marketplace are prohibited from turning you down based on your health status or your immigration status and must follow generally the same rules as plans in the Marketplace. To obtain coverage, contact a state-licensed health insurance company or a licensed agent or broker. Your state Department of Insurance can help you find one.  

Can I get help with my Marketplace application?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Yes! Hummingbird Insurance offers free consultations and help through our certified agents. If you need help with understanding which plan is best for you, book an appointment with us today! Working with us is always free and can help you to save money.

Additionally, all state Marketplaces are required to offer Navigator programs to help consumers complete their application for  financial help, including help applying for Medicaid or CHIP.  Navigators also help people review their plan choices and appeal Marketplace decisions.  Navigators are paid by the Marketplace, not by health plans, and they must complete Marketplace training and be free from conflicts of interest.