Affordable Care Act
Insurance Renewing Early? You May Qualify for New Health Care
Published on September 15, 2014
New eHealth eBook “Health Plans: Know When to Hold ‘Em Know When to Fold ‘Em”
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Qualifying for New Health Care
If you’re one of the countless Americans who purchased a health insurance plan before January 1, 2014, your health plan may be discontinuing sometime this year.
As a result of the Affordable Care Act, any “non-granfathered” health insurance plan that do not have all of the essential benefits required by law, must be eventually updated or potentially canceled. Note, that typically you’ll receive a notice from your insurance carrier 60-90 days before your health insurance plan will be ending or changing.
To help you decipher what’s happening with your health plan we’ve put together:
- A custom eHealth’s action plan tool
- A special edition ebook, “Health Plans: Know When to Hold’em, Know When to Fold’em,”
- Six of our most frequently asked questions,
- Tips For Shopping,
- And Tips For Why, How, and When Your Plan Will End
- A video, “Health plan being cancelled in 2015? Here are three things you need to know.”
Frequently Asked Questions
1. QUESTION: I thought that I could keep my health insurance policy if I like it? Is that still true?
Answer: Yes, and No. The Affordable Care Act did create a category of health plans with “grandfathered status,” but not all plans get that status.
Here are the three types of individual major medical health plans that exist today:
– Grandfathered plans: If coverage under your current plan started before March 23, 2010 – when the Affordable Care Act was signed into law – you may have a grandfathered plan, and depending on your insurance carrier, you should be able to keep that plan. But, you should know that you can’t use a government subsidy to help you pay for a grandfathered plan.
– Non-grandfathered plans: If you bought major medical health insurance after March 23, 2010, and your coverage started before January 1, 2014, you have a non-grandfathered plan. Originally these plans were supposed to be replaced by 2014. But, federal regulations gave states the option to allow insurers to extend some non-grandfathered plans through 2017.
– New plans: If you purchased major medical health insurance with coverage starting January 1, 2014 or later, your plan should meet all of the mandatory benefits required by the Affordable Care Act.
2. QUESTION: If I lose my plan, and I have a pre-existing medical condition, can I be turned down for health insurance when I shop for a new plan?
Answer: No. The health care reform law no longer allows insurers to decline your application because of your personal medical history or any current medical conditions. But, you do need to buy coverage during open enrollment or when you’ve experienced a major qualifying life event, like a move, loss of coverage, or certain changes in your family. Major medical insurance may not be for sale during other times.
3. QUESTION: What’s going to change when I switch to my new health plan?
Answer: When you switch to a new, fully-reformed health insurance plan, you might notice changes to your coverage like the following:
– No Annual Coverage Limits: Annual dollar limits on most covered medical services will go away.
– No cost-sharing for some Preventive Services: The Affordable Care Act requires insurance companies to provide certain recommended preventive services without any out-of-pocket cost to you.
– Community Rating: The cost of any given health insurance plan will be the same for all people your age in your community – it may change if you’re a smoker, but it won’t vary based on your other personal health factors.
– Essential Health Benefits: All health plans must cover ten categories of essential health benefits defined by the government.
– Actuarial Values: Plans are now built to cover at least 60% of the average consumer’s expected medical costs during the year.
4. QUESTION: When will my grandfathered plan change?
Answer: Depending on which insurance company you have, your plan could be changing in any of three ways:
– Passive Re-enrollment: Your insurance company may choose to “passively re-enroll” you into a health care reform-compliant plan. They’ll notify you of their intent to change your coverage, but you don’t have to do anything if you want to accept the new plan.
– Active Re-enrollment: Some insurance companies may require you to actively opt into a new plan, which may involve you submitting a new application.
– Active Communication, Non-Enrollment: Some insurers will just make you aware you’re your current plan doesn’t meet new government standards and let you know when the pan will end, but they won’t take any action to transition you to a new plan.
5. QUESTION: “When is the open enrollment period for 2015?”
Answer: Open enrollment is a period of time when anyone can enroll or change their coverage. The open enrollment period for 2015 coverage runs from November 15, 2014 – February 15, 2015.
Outside of open enrollment, you can also trigger a 60-day “special enrollment period” any time during the year if you experience a “qualifying life event.”
Qualifying life events include things like losing your existing major medical health insurance plan, a change of family structure (marriage, divorced, have or adopt a child), a change in your citizenship, or a move to a new coverage area.
6. QUESTION: “Do I have to buy health insurance through one of the government web sites now?”
The Affordable Care Act allows you to purchase certain types of health insurance plans through government run “exchanges” or marketplaces. But, in most states, you can also buy these plans through licensed private online marketplaces, licensed agents, or directly from the insurance company.
The plan you choose will cost the same no matter where you buy it.
Using an agent and purchasing your coverage outside of a government exchange can offer you several advantages. All of our agents undergo criminal background checks, pass strict state licensing exams, and can recommend plans based on your individual needs. And, you’ll find plans that protect you from tax penalties but are not available on government exchanges.
Tips For Shopping
If you have to change your health plan this year, here are three things you need to know:
1. Don’t assume your new plan is JUST like your old plan – If your plan is changing, your insurer may be offering to put you into a new plan, or recommending you switch to a plan they sell. Their recommended plan may be an excellent plan, but you should check it for yourself before you make the move. Our p¬¬hysician finder tool can help you make sure your doctor is in the plan’s network, and our licensed agents can help you answer specific questions about plan benefits.
2. You may qualify for a subsidy to help lower your costs – a lot of our customers experience sticker shock when they see the price of the new plan their insurance company is transitioning them to. It’s true that, on average, the new plans are more expensive, but they also typically guarantee more benefits, and you may qualify for a subsidy to help bring your costs down.
3. Shop for coverage at eHealth – As a federally and state licensed web-broker, eHealth has a wide selection of qualified health plans that can be purchased at our site using a government subsidy, if you qualify. But, eHealth also has major medical health insurance plans available from brand-name insurance companies that are not available on government exchanges, at all. And, these plans protect you from the uninsured tax penalty.
Tips For Why, How, and When Your Plan Will End
1. Know why your health insurance plan is ending – If your major medical health insurance plan was bought after March 23, 2010 and your coverage started before January 1, 2014, your plan is not a “grandfathered” plan. Truly grandfathered health insurance plans were in effect on March 22, 2010, the day before the Affordable Care Act was signed into law.
Your current plan may not meet all of the new benefit standards of the ACA – like coverage for the 10 essential benefits required by the law – and your plan will likely need to be updated by 2017, if not sooner. Typically, insurance companies will notify you two months before your plan is ending.
2. Know how your health plan will change – There are three was insurance companies will transition you to a new plan:
a. The first is Passive Re-enrollment: Your insurance company may choose to “passively re-enroll” you into a health care reform-compliant plan. And, you won’t have to do anything if you want to accept the new plan.
b. The second is Active Re-enrollment: Some insurance companies may require you to actively opt into a new plan, which may involve a submitting a new application.c. Active Communication, Non-Enrollment: Although many insurance companies are allowing customers to keep their existing plans as long as possible, current law only allows those plans to stay in place until 2017, at the latest.
3. Know when your plan will change – Insurers will typically: a. During the open enrollment period: Your insurance company might use a passive re-enrollment or active re-enrollment to transition you from a non-grandfathered plan to a new ACA-compliant plan, during the open enrollment period that runs from November 15th, 2014 through February 15, 2015.
b. On your plan’s renewal date/anniversary date: Some insurers may actively or passively re-enroll members when plans are up for renewal (one year after the plan started).
- Find out if your plan is changing using: eHealth’s action plan tool
- Download the special edition ebook, “Health Plans: Know When to Hold’em, Know When to Fold’em”
- Learn about changing plans in this video: “If I’m covered by a non-grandfathered plan, do I need to change plans in 2014?”