How Can I Get Health Insurance Now?

The Affordable Care Act has been a success for many people in the United States. However, it is important to make sure you know your status and how to get health insurance now. The following blog post will help you find out what type of coverage might work best for you and provide some links that can help answer any questions about health care reform.

Special Enrollment Periods and Qualifying Life Events

The Patient Protection and Affordable Care Act (PPACA) requires qualified individuals to have health insurance coverage throughout the year. Individuals who go without health care coverage for three consecutive months or more may have to pay a tax penalty when filing their federal income taxes unless they qualify for a waiver or exemption.

However, individuals can be exempted from this requirement if they experience certain qualifying life events such as having a baby, changing jobs, or getting married. These event-driven special enrollment periods allow the opportunity for individuals to gain coverage outside of the yearly open enrollment period when they may have otherwise gone uninsured due to procrastination.

Employers can also leverage these opportunities by offering targeted group health plan coverage during specific events like the open enrollment period, which allows employees to choose between various plan options.

During 2016, nearly 2 million non-elderly adults were covered with private insurance through special enrollment periods (SEPs), compared to 1.7 million in 2015 and 660,000 in 2014 according to a new analysis by The Commonwealth Fund.

A majority of these individuals were previously uninsured, while the rest switched from other forms of insurance such as Medicaid. While private plans are not required to provide SEPs, employers can take advantage of this opportunity by offering targeted coverage through special enrollment periods that align with their workforce needs.

The increase in enrollment also corresponds with an increase in awareness of special enrollment periods. According to an August Kaiser Family Foundation (KFF) poll, 61% of Americans are aware that the ACA requires insurers to provide consumers with a special enrollment period in certain situations. This is compared to 30% in 2014 when KFF asked similar questions about awareness of SEPs.

In 2016, nearly 1 million adults purchased coverage through a special enrollment period, and nearly half of these consumers were previously uninsured.

Among those insured adults who purchased coverage through a SEP in 2016

49% had been uninsured for more than two years, while 19% were uninsured for at least six months. In comparison, 25% of previously insured adults who signed up outside of a SEP were uninsured for at least six months.

Half of the adults who purchased coverage through a SEP in 2016 also switched from Medicaid or the Children’s Health Insurance Program (CHIP). The other half were previously uninsured and likely had their coverage initiated within a SEP to avoid a potential tax penalty.

Enrolling in a Short-Term Medical Plan may Not Affect Your Quality of Care

Cynthia Cox, Associate Director for the Program for the Study of Health Reform and Private Insurance in the Public Policy Research Institute at Texas A&M University in College Station, discusses key findings from her research on short-term medical plans. Photo by Nick Oxford for KVUE News (via Flickr)

In an analysis published this month, Cynthia Cox, Associate Director for the Program of the Study of Health Reform and Private Insurance in the Public Policy Research Institute at Texas A&M University in College Station, found that if you’re healthy, enrolling in a short-term medical plan could have no effect on your quality of care or your out-of-pocket spending.

“[In] the short-term plan, there’s no coverage for things like prescription drugs or maternity care,” Cox told KVUE News. “Some people call them junk insurance.”

Cox said that based on her study of a previous five-year period, people who enrolled in a short-term medical plan during 2017 paid 1 percent more out of pocket for healthcare than those who enrolled in an Obamacare plan.

“Most people,” Cox said,” already have some form of coverage.” [ARTICLE END]

Key findings from the study

People with short-term policies were subject to out-of-pocket spending at similar levels as those with ACA exchange plans (ACA) and Medicaid. However, short-term policyholders paid only monthly premiums whereas those with ACA and Medicaid plans faced a range of out-of-pocket costs.

The vast majority of 2014–2017 short-term medical policies excluded coverage for prescription drugs and maternity care, even though 13 percent of all nonelderly adults have a chronic condition that requires regular access to prescription drugs and 12 percent have a disability.

According to the researchers, only 4 percent of short-term policyholders had out-of-pocket expenditures for non-urgent healthcare that were similar to those with ACA plans.

People who enrolled in short-term health insurance had access to care from providers but lower rates of getting healthcare services.

Getting Covered Under Medicaid/CHIP as a Child

When children turn 18 years old, they often become ineligible for Medicaid and the Children’s Health Insurance Program (CHIP). Here are some tips on how to stay covered under these programs if you’re over 18 but still considered a young adult by the state.

You may be able to stay on your parents’ health insurance plan – CHIP and Medicaid often cover children through the age of 19 or 21, if they are in school. To find out more about your state’s rules, contact your local Medicaid office (to find the number, go to To find out more about your state’s rules, contact your local Medicaid office (to find the number, go to Benefits.gov ).

Not all programs are open to all young adults. For example, some states allow 21-year olds with disabilities to receive coverage through Medicaid or CHIP for services that aren’t offered elsewhere. But “If you can live at home, you can often stay on your parents’ health plan if they have one,” says Kathy Pickering, Executive Director of the Health Access Project. Your employer’s health plan may also cover you if you are under 26 years old (this is a requirement for individual coverage under the Affordable Care Act).

You can look into getting your own insurance through the private market. The best way to find affordable health insurance is by shopping online. To get a sense of what you might pay, go to a health care exchange site. Your state may have its own state-based marketplace or you can shop for coverage at the federal level at HealthCare.gov.

Need Help Getting Insured? The Affordable Care Act May Be For You!

The Patient Protection and Affordable Care Act (also known as the ACA or Obamacare) is a law that includes provisions for people who are uninsured or underinsured. These include young adults, students, part-time workers, individuals with pre-existing medical conditions, and/or those who cannot afford health insurance. For details, please click here.

Starting October 1st, 2013, qualified residents in California may apply for health coverage at CoveredCA.com (the official state marketplace website). Please visit the site for more information about applying and enrolling in health care plans during this Open Enrollment period.

If you need help paying for your insurance plan, the Affordable Care Act may provide additional financial assistance to those who earn less than four times the Federal Poverty Level (which is currently $45,960 for a single person and $94,200 for a family of four). If you qualify, tax credits can be used towards the purchase of a health insurance plan.

To see if you qualify for financial assistance, please click here to take a look at the Kaiser Family Foundation’s ACA Subsidy Calculator. The calculator will give you an estimate of the cost of your monthly premiums and how much it might be reduced by applying for financial assistance.

Conclusion

It can be difficult to find a good insurance plan. The Affordable Care Act may help you get the coverage you need, but there are many steps in this process and it’s easy to become overwhelmed with all of them at once. Let our team do the work for you!

We’ll walk through what information is needed so that we can best determine which plans will meet your needs- whether they’re short-term or permanent. Contact us today if you have any questions about how enrollment periods apply to quality care, Medicaid/CHIP eligibility as a child, or other options available now under Obamacare!