Open Enrollment -The Market Place – Health Insurance


YES… YES… YES…

It is that time of year again. That specified time you must choose a health plan or you will get fined, taxed, or whatever you want to call it. Open Enrollment started November 1st and it goes through January 31, 2017. So here are some important dates.

November 1st – Open Enrollment Begins

December 15th – Enroll by this date to get a Jan 1st effective date

January 31st – End of Open Enrollment.

To help you manage your way through this Open Enrollment time we are here to guide you. There are many things you need to have once you set an appointment with us.

First –

You must decide if you want to use your “subsidy” (tax return money) to pay for your monthly premiums. We will walk through the application online with you to see if you qualify and how much you qualify for. I have a Marketplace Application Checklist link for you to help you with what you will need for us to get the application completed.

Second –

Once you have all of your information gathered we can start on the application see if you qualify for a subsidy, only if you want to use it then we can start to pick a plan for you and/ or your family. You will want an idea of how much you can spend each month on your health insurance and the benefits you want as well. Remember that higher the deductible and Out of Pocket Maximum the lower your Monthly Premiums.

Third –

Once you have picked your plan we can apply right then and there online. Remember there is NO underwriting process – everything is “guaranteed issued.” Your pre-existing condition(s) is/are covered. You have $0 copay’s for your Yearly Preventative health check ups. Here are a few more benefits:

All Marketplace plans must cover treatment for pre-existing medical conditions.

  • No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
  • Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
  • Medicaid and the Children’s Health Insurance Program (CHIP) also can’t refuse to cover you or charge you more because of your pre-existing condition.

Pregnancy is covered from the day your plan starts

  • If you’re pregnant when you apply, an insurance plan can’t reject you or charge you more because of your pregnancy.
  • Once you’re enrolled, your pregnancy and childbirth are covered from the day your plan starts.

Grandfathered plans don’t have to cover pre-existing conditions or preventive care. If you have a grandfathered plan and want pre-existing conditions covered, you have 2 options:

  • You can switch to a Marketplace plan that will cover them during Open Enrollment.
  • You can buy a Marketplace plan outside Open Enrollment when your grandfathered plan year ends, and you’ll qualify for a Special Enrollment Period.

All plans offered in the Marketplace cover the same set of essential health benefits.

Every health plan must cover the following services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Preventive services for all adults, women, and children

There are 3 sets of free preventive services. Select the links below to see a list of covered services for each group:

We are here to help and guide you through this process. If you have any questions please feel to contact us via website or you can call 386-574-3030 x211

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