I want to purchase a Health insurance policy off the exchange.
Currently, no health insurance companies are offering individual policy off the exchange for Hoosiers under 65. (This includes Anthem, Humana, UnitedHealthcare, IU Health Plans, Assurant & Aetna) They have all exited the Indiana Individual market.
Can I purchase a policy?
There are limited times in which you can purchase a policy through the exchange. Open enrollment is the time of year in which you can apply November 1st through December 15th. Outside open enrollment then you must have what’s called a qualifying event (QLE). Examples of QLE
Involuntary loss of prior health coverage.
You stop working for a company that provides group health insurance coverage. You are turning 26 and being dropped from a parent’s health plan. Your cobra runs out. You no longer qualify for subsidized health policy through the state.
Changes in Family Households:
You get married or divorced. Childbirth Death in the family.
Changes in state residence:
Move to a new state
Becoming a US citizen is a QLE.
How long do I have to apply after a Qualifying event occurs?
You have 60 days to apply! After 60 days you are no longer eligible for coverage. You must apply in that 60-day window.
Will my preexisting conditions be covered?
If you purchase a health insurance policy through the marketplace, it must cover all preexisting conditions.
Will the health insurance policy cover my prescriptions drugs?
The insurance companies have a list of covered drugs called a drug formulary. You will have to research your medications to see if they are covered and at what level. Many brand name drugs may go towards the deductible leaving you with paying for those drugs until the deductible is met.
I want to purchase a PPO individual insurance policy.
They are currently not offered; you have the option of a Health Maintenance Organization (HMO) or Exclusive provider organization (EPO). Both options provide little to no coverage out of the network.
Will there be coverage out of network?
Typically, emergency room visits are covered out of network. Any other out of network services will most likely not be covered.
Will my current doctors accept this health insurance?
The insurance companies have established provider networks. It is easy to search the networks to determine if your current physicians are in network. Make sure you have the correct spelling of the physician name.
If my doctor is in-network does that guarantee they will accept the insurance?
We have seen medical practices limit the number of patients that have a health insurance policy through the exchange. We have also seen physicians drop out of network mid-year.
I can’t afford the cost of health insurance.
With the health insurance policy being through the exchange, you are eligible to apply for advanced tax credits to reduce your monthly premium. To be eligible, your household income must be below the 400% of the federal poverty level, and you can’t have access to other coverage that is considered affordable.
Cost Sharing Reductions (CSR)
Depending on your income, you could qualify for a health plan that has lower deductibles and out of pocket maxes. This can significantly reduce your potential out of pocket.
How do I apply for the premium assistance aka tax credit?
You can apply when you apply for coverage, and you will be asked if you want assistance with lowering your premium and then you will answer housed hold income questions.
Plan Designs Election Guide:
When it comes to selecting the best plan design for you and your loved ones.
Out of pocket Maximum (OPM) is the total dollar amount a member will pay in one year for in-network claims.
The Individual policies under the ACA have significant out of pocket Maximums which will continue to rise. If you have high claims, you may be better off going with a plan that has a lower out of pocket maximum even though the cost is upfront.
If you anticipate little to no claims, having the highest OPM could work in your favor of reducing cost.
What is a deductible?
It is the upfront amount the member will pay before the insurance benefits start to pay. Those initial claims are still processed with the network discount.
Get In Touch
Nefouse & Associates, Inc.
8465 Keystone Crossing