Marketplace Plans with Access to Tax Credits
If you are eligible for a tax credit to lower your monthly premium, your application will need to be processed either through the federal marketplace, Healthcare.gov in Oregon or through a state marketplace such as the Washington Healthplan Finder.
Marketplace applications require an online account to be set up if one is not already in place. The initial application for a new account will require a username, passwords and security questions to set up an account. Please be sure to keep your information in a secure location so you can find them when you need to log back in.
Direct Insurance Plans
If you are not eligible for tax credits to lower your premium, we can assist you in applying directly to your selected insurance company and skip the marketplace account and application process.
Faith-Based Programs
Faith-Based sharing programs provide a little lower-cost alternative to a Qualified Health Insurance plan. A Faith-Based plan is not insurance. Most plans use the word "sharing" instead of insurance. A feature of these programs besides their lower price point is the availability to enroll in a Faith-Based program outside of open enrollment.
These programs have a monthly amount that is paid similar to a premium. They usually require the member to pay an amount up front before services are shared financially by the plan sponsor and its members.
The amount required can be selected at the time of purchase with many options available. The largest amount of up-front sharing is around $10,000, with many options for lower sharing amounts. After your initial sharing most plans will pay for 80% of an approved expense and the member pays the remaining 20%.
To keep costs down these programs are organized differently than a Qualified Health Plan:
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Your program may have no or limited preventative services.
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Your program may require waiting periods for pre-existing conditions that may last from 1-3 years in length.
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Your program may have no or limited prescription drugs plans.
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Your program may have both a yearly limit and a lifetime sharing limit.
Check with our office to see if a Faith-Based program is the right choice for you.
Short-Term Insurance
There may be times when you need health insurance for just a small amount of time. Short-Term insurance is a tool for these moments. Most policies last around 90 days and some policies may be able to renew at least one time. Policy availability and durations may vary depending on state insurance rules.
A Short-Term plan does not cover pre-existing conditions. They are true insurance in the fact that you can pick a deductible and select your co-insurance amount. Your plan will likely have a lifetime limit.
Your premium is charged by the day versus monthly due to the limited time of the plan’s operation.
Please let us know if you would like to see if a short-term plan is a good fit for your needs.
What is a Qualified Health Plan?
A Qualified Health Insurance Plan is one that has been structured by the federal government to guarantee customers get the same level of benefits in certain areas of their plan.
Common benefits include:
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No waiting periods for pre-existing conditions
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No-cost preventive services
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No lifetime limits to coverage
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Mental health and substance use services
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Prescription drug benefit
What is Open Enrollment?
Open Enrollment is the period of time set by the Federal Government during which individual health insurance plans may be sold guarantee issue.
Open Enrollment for the last few years has been November 1 – December 15 for a January 1 effective date. These dates are set by the Federal government and could change each year. States also have some control and could extend those dates. If you lose coverage during the year because of non-payment of premium you cannot re-enroll in another plan until the next open enrollment period.
What is a Special Election Period?
A Special Election Period is the exception for enrolling in an individual plan outside of Open Enrollment.
There are many Special Election Period (SEP) allowances:
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Loss of Employer-Sponsored Group coverage
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Birth of a child or adoption
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Divorce
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Marriage
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Moving outside of the coverage area
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Loss of Medicaid
Please note that on average you have 60 days to apply for a new health insurance plan otherwise your Special Election Period expires.
Six Considerations when Choosing a Health Insurance Plan
Premium Tax Credits
Do you qualify for premium assistance? Talk with one of our agents to see if you might be eligible for tax credits to reduce your monthly premium.
Doctor Visits
Some policies may limit your access to doctor visits until your deductible has been paid outside of preventative. Know your benefits.
Deductibles
Insurance companies offer many different products with varying deductibles, make sure you are getting the deductible that is right for you.
Total Out of Pocket
If you have a family your TOOP may be different than a policy for one person. Ask about your total costs.
Doctor & Hospital Networks
Insurance companies are narrowing access to doctors and hospitals in order to control premium prices. Make sure you know the network of your policy before you buy.
Prescriptions
Insurance companies have a list of covered medications called formularies. Always check to make sure the medication you are taking is on the company's formulary.
You are your Most Valuable Asset!
Let’s be honest—in today’s hectic world, it’s often easy to neglect some of the most basic aspects of caring for ourselves and our families. While you’ll quickly notice if you run out of groceries, little things like doctor and dentist appointments are easy to shift to one side—that is, until illness or injury sideline someone. When you have to put the world on hold, who’s going to help you make sure it doesn’t crash back in on you when the medical crisis is over?
Acquiring and maintaining good health insurance coverage is one of the most important things you can do to protect yourself and your family.
It protects your ability to earn a living.
Waiting till something is wrong to see a doctor means you’ve already potentially lost income. With medical coverage for preventive care, you can catch small issues before they become big problems, potentially saving yourself tens of thousands of dollars.
It protects your wealth.
No one puts money in a savings account or investment and thinks, “I really hope I can use this to pay medical bills.” You’d rather take a vacation, do some home improvement, or build your retirement account. Good health care coverage will help you protect your wealth.
It gives you peace of mind.
Knowing you have a safety net under you can relieve a burden you might not even know you’re carrying. When you can go about your daily tasks without worrying about how even a minor medical issue could derail your life, you free your mind to better activities—like performing at your peak in daily life and planning for a full and active future.
You are your most valuable asset. Protect yourself and your family by making the investment in good health coverage today.
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