Affordable Care Act
eHealth Agents Answer Common Health Insurance Questions
Published on March 11, 2016
The 2016 open enrollment period is over but if you recently enrolled in health insurance, you may have some questions about your new plan.
Answering your questions, even after you buy, is just one way licensed agents are so great.
Did you know that the “navigators” working at government website usually aren’t licensed health insurance agents? It’s true. And if they’re not licensed agents, they generally can’t answer detailed coverage questions or recommend specific plans based on your personal needs.
So, what are some of the common questions eHealth agents are answering these days? Take a look:
QUESTION: “Can I still get health insurance outside of open enrollment?”
ANSWER: The Affordable Care Act (the law commonly known as “Obamacare”), created limited open enrollment periods during which anyone can sign up for individual or family health insurance. The open enrollment period for 2016 coverage ended January 31, 2016. However, if you experience a qualifying life event, you may still be able to sign up for a new 2016 plan. Qualifying life events include things like getting married or divorced, having or adopting a child, losing your employer-based coverage, or permanently moving to a new coverage area. If you experience a qualifying life event, you will have sixty days to sign up for a new plan.
QUESTION: “I recently enrolled in coverage. When will I get my health insurance card?”
ANSWER: Most health insurance company’s mail out ID cards within 7-10 business days, but it may take up to 3-4 weeks for health insurance cards to arrive. If you need to use your coverage right away, don’t hesitate to call your insurance company directly. They will be able to give you the coverage information you need to pass on to the doctor, and may be able to help you print a temporary ID card at home.
QUESTION: “What is a 1095 form and how do I get mine?”
ANSWER: 1095 forms serve as proof of coverage and, for those who qualify, eligibility for government subsidies. You may need a 1095 form to complete your federal tax return for 2015.
If you got a government subsidy to help you cover your monthly insurance premiums in 2015, you should expect a 1095-A form from the government-run exchange in your state, even if you enrolled through a private marketplace like eHealth. If you have not received your form yet, contact the government exchange serving your state to confirm they have your correct mailing address.
If you had 2015 health insurance coverage without a subsidy, you should get a 1095-B form from your insurance company. If you haven’t received your form yet, you should contact the insurance company to confirm they have your correct mailing address on file.
There are no 1095 forms for short-term medical, dental insurance, or any other type of supplemental coverage. Please speak with your tax professional for further clarification on how to use your 1095 form with your taxes.
QUESTION: “When is my insurance payment considered late?”
ANSWER: Each insurance company has their own guidelines determining when a payment is considered late, or if a grace period for late payments is allowed. Call your insurance company directly to clear this up, and consider setting up an automatic monthly payment to prevent any future problems.
If your payment is so late that your coverage has been cancelled, be aware that loss of coverage due to non-payment is not a qualifying life event. It will not make you eligible to enroll in a different health plan before the next open enrollment period.
If you need to change your billing information, it is critical that you contact your insurance company as soon as possible to update them and to ensure there is no problem with your payments moving forward.
QUESTION: “I’m moving to a new city/state, what do I do?”
ANSWER: If you are moving to a new coverage area, this is considered a qualifying life event and you will typically have a sixty-day window to enroll in a new health insurance plan. This is important because health insurance coverage is generally limited to medical providers within a specific geographical area. Medical care rendered by doctors and hospitals outside your network may be covered at a reduced rate or not at all.
If you purchased your plan through eHealth, contact us. We’ll help you select a new plan, and let you know what documentation is needed to show proof of the move. We will also help cancel your old coverage. Even if you’re only moving within the same city, we can update your information on our files and help you update it with the insurance company.
If you purchased your coverage through a government-run website or directly from an insurance company, give them a call to have your information updated and to cancel your old plan, if appropriate.