Frequently Asked Questions

Health Insurance F.A.Q’s


What is OEP?

O.E.P. stands for “Open Enrollment Period”  and refers to the time of year when anyone can purchase and enroll in a health insurance plan through the federal or a state on-line marketplace.  OEP was created as part of the federal health insurance law passed in 2012 called the Affordable Care Act.

When is OEP?

Open Enrollment begins on November 1st and ends on January 31st, every year.  You’ll need to enroll by December 15th to have health insurance that goes into effect on January 1st.  If you wait until after December 15th you can still get health insurance for the upcoming year but the effective start dates are:

  • FEBRUARY 1st: Enroll between December 16 & January 15
  • MARCH 1st: Enroll between January 16 and January 31

Who can buy health insurance on the Marketplace?

The Health Insurance Marketplace is for people who don’t have health insurance.  Because of the Affordable Care Act, you don’t have to have a job to qualify… And… you can’t be denied coverage because of pre-existing health conditions.

If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program which is also known as CHIP, you can buy insurance through the marketplace.

If you have health insurance offered by your employer, you can buy a plan through the Marketplace, but you’ll pay full price unless your employer’s insurance doesn’t meet certain standards.

If you have Medicare you can’t switch to Marketplace insurance.

How Much Will Health Insurance Cost?

What you pay for insurance depends on your household income, your zip code, and your family size. Your savings depend on how much you estimate your total household income for the year.

This year, about 8 in 10 families and individuals will qualify for financial assistance to lower the cost of their monthly premiums.  It only takes a couple minutes to determine if you qualify for a premium tax credit.  Call and talk with one of our agents or view your options here.

Plans are offered by private insurance companies with a range of prices and features. All plans cover:

  • Essential health benefits
  • Pre-existing conditions, including pregnancy
  • Preventive care

What’s The Penalty for Not Having Health Insurance?

If you don’t have health insurance, you may have to pay a fee with your federal taxes. You need to have health insurance for at least 9 consecutive months each year or you’ll pay a penalty of either 2.5% of your income, or $695 per adult and  $347.50 per child, whichever is higher.

There are some cases, where a person might qualify for an “exemption” from the requirement to have health insurance. You’ll need to talk with a CPA or tax expert about these exemptions.

What Are Options If I Lose My Group Health Plan After OEP?

Many people have different situations throughout the year that will qualify them to enroll in a health insurance plan outside of OEP.  You will qualify to enroll in a Marketplace Plan anytime of the year if you have a “Qualifying Event”.  If one of these occur, then you have a Special Enrollment Period (SEP). Your SEP will give you 60 days to choose a new plan.  If you wait longer than 60 days, you will not be able to enroll in health insurance and you’ll have to wait until the next Open Enrollment Period. Don’t get caught without health insurance.  Make sure you call us if you experience an SEP!

Qualifying Events for a Special Enrollment include:

  • Moving to a new zip code
  • New job or losing group coverage
  • Turning 26
  • Having a baby or adopting a child
  • Getting Married or divorced

What Happens If I Forget To Make My Health Insurance Premium?

Don’t forget to make your monthly health insurance premiums.  If you don’t make your payment within 60 days of the due date your insurance will be cancelled and you will not be able to get health insurance again until the next open enrollment, or when/if you have an SEP.

How Do I Cancel My Health Plan If I Get A Job That Offers Health Insurance?

Call your health insurance carrier directly and inform them that you have new health insurance and you need to cancel your plan.  If you are on auto payment you will want to cancel your policy before the last day of your coverage effective date. If you don’t you will be charged and you won’t get a refund.

 

 

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