Broker Check

Be educated on your health insurance options

May 29, 2020

Right now, I am seeing things out there about how so many Americans are losing coverage vs others countries.  While it is true that we do not have a universal healthcare system like other countries and yes, people are losing coverage because they are losing jobs, this was a big part in why the current Affordable Care Act system was put into place.  Do I think it’s perfect, absolutely not, but it does allow individuals who lost coverage to get health insurance.  So, while American’s may lose their current coverage, they do not lose the ability to have health insurance as a whole as long as you sign up within 60 days.  Yes, you now have to make an effort to either figure out how to attain it themselves, or reach out to someone for help, but insurance is available to you. A huge part of my job is working with health insurance.  Somedays, I feel like I live and breathe it and could literally talk to you for hours about it.  I promise I won’t be that long winded.  I want to help educate people on how it works and make sure that those that want or need health insurance, feel confident reaching out or obtaining on their own if they choose.  To start out, some tidbits on the current state of health insurance:

-2014 began the start of the Affordable Care Act laws.  We saw our first open enrollment for people at the beginning of that year.  It was extended a couple times.  By 2016, It had been officially changed to November 1st – December 15th if your state was using the federal exchange ( – source and website for information). 

-A person can still get health insurance year-round, but outside of that open enrollment, you must have a qualifying event.  There is a whole range of qualifying events, but the biggest piece to all of it, is that you have to have had coverage for at least 1 day in the last 60 days.  That coverage must have also been terminated involuntarily, meaning you did not terminate it by request or due to non-payment.

-The individual and family plan side is different than groups and Medicare.  For those that are blessed to have benefits through an employer, while the cost can and is high at times, in general, you will have lower out of pocket expenses.  It’s not always the case, but in most cases it is.   

-The best thing you can do is BE PROACTIVE.

If you know you are quitting, cutting back hours and losing benefits, start your search early if possible.  If the loss of benefits is sudden, start your research as soon as you can.  If you have group benefits, know your COBRA rights and costs.  Know there might be other options out there and ASK for help.  A big part of what we do is assess your situation and help you decide what is the best option for you.  Does COBRA make sense? Would you qualify for coverage through the marketplace and be eligible for a tax credit?  If not, what other options might I have?  If you currently have an HSA (Health Savings Account) through your employer, is that something you wish to continue to contribute to?  You might not be able to contribute to the same one depending on employer rules, but if you like the idea of them, the tax advantages and long-term use, we want to make sure that is still an option for you.  Don’t settle for someone telling you to take something and not worry.  ASK QUESTIONS. 

Using the marketplace and taking a tax credit has some good and some bad.  The good – it can save you money on your monthly premium.  Depending where your income qualifies, it can even reduce your deductibles and out of pocket maximums because you qualify for cost share reduction.  Another pro is that if you are on the marketplace, you have the ability to adjust your income during the year, which in turn will adjust your premium.  So, say you were working, weren’t offered benefits, and had a plan through the marketplace.  Now, you lost your job.  You can go in, update your application and reflect that you now have no current income, which should lower your premium you pay, hopefully affording you a way to keep your coverage during a tough time.  The negative side is that if your income is higher than what you predict, you will have to pay some of that back.  So make sure when entering income that it’s accurate and not too low.  Typically, when someone comes in, we have them bring in their last year’s tax records so we can go line by line, especially in potential complex situations.  If a person just has one job and no other income such as capital gains, rentals, farming, etc, we just ask for their last pay stub.  It may seem in depth, but the more accurate we can be, the better things are when a person files their taxes the following spring for that tax year. 

Another area of health insurance that doesn’t get taken into consider is in divorce situations.  When parents are on group plans, it’s generally a non-issue.  When one or both parents have to seek out their own health insurance, it can become a big issue.  A lot of times, it becomes one parents responsibility to cover a child or children and maybe both parents help with expenses otherwise.  Then comes to the part of claiming.  Depending on the number of kids, if it’s an odd number of kids, they rotate, if it’s an even number they just split the kids.  This is where problems can exist.  With the marketplace, unless you claim that child, you cannot take a tax credit for that child.  This can sometimes cost the parents providing health insurance, hundreds more per month to insure their child because of how the tax credits work.  So my suggestion, to lawyers and parents in this situation.  Learn more about their health insurance situation before deciding what rules should be followed in the divorce decree. 

Again, be proactive if you are losing coverage.  Don’t just put it aside and don't assume it's too expensive.  I'd rather have a conversation with you right when you are losing coverage so you know your options, rather then you calling me because you now have an ailment 6 months later that you need insurance and learning that you can't. We WANT to help because your health and finances matter.