When Should I sign up for a new Healthcare plan?
Health Open Enrollment starts yearly on November 1. You could qualify for a special enrollment period (explained below) which would allow you to sign up at any time. Short Term plans are also available 365 days per year.
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What determines a special enrollment period for Healthcare Enrollment?
A time outside the yearly Open Enrollment Period when you can sign up for health insurance.
You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.
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Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan. You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) at any time. Job-based plans must provide a Special Enrollment Period of at least 30 days.
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What's the difference between a PPO and a HMO?
PPO (Preferred Provider Organization) plans have a network of providers that are considered “in-network.” If you choose to visit in-network doctors or specialists, you will pay less than you would for out-of-network providers. You do not have to choose a primary care doctor. You are free to visit any provider that is in-network.
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HMO (Health Maintenance Organization) plans typically require that you choose a primary care physician (PCP). All of your health care is coordinated through your PCP. Make sure your PCP is in-network before choosing this type of plan
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Premiums, Co-Pays, CoInsurance, and Deductibles - what's the difference?
Premiums are a monthly fixed amount you pay for your health insurance. These amounts will vary based on the type of coverage you select, your zip code, your annual income, etc.
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A copay is a fee you are required to pay for specific medical services. Depending on your plan, you may have different copays for doctor visits, specialist visits, and prescriptions.
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Some health insurance plans require the payment of a certain amount out of pocket before your medical expenses are covered, this is known as a deductible. Once your deductible is met, your plan may cover some or all of your expenses.
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If you have a coinsurance plan, your provider will pay a percentage of your expenses and you pay the rest.
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What is a premium tax credit? How do I know if I am qualified?
A premium tax credit is a tax credit you can use to lower your monthly insurance payment (premium) when you enroll in an independent health insurance plan. Your tax credit is based on the income estimate and household information you put on your application. Eligibility varies depending on your zip code, life changes, etc.
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​To determine your eligibility:
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Start with your household's adjusted gross income (remember - savings are based on your income estimate for the year you want coverage, not last year)
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Include everyone in your household - count yourself, your spouse if you're married, plus everyone you'll claim as a tax dependent, including those who don't need coverage.
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Does my plan include dental and vision insurance?
Some health policies do include health and dental benefits. You can also add supplemental dental and vision coverage through some of our providers. View those policies by visiting our Supplemental Policies pages.
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Is there a penalty for not having Health insurance?
Starting with the 2019 plan year (for which you’ll file taxes by July 15, 2020), the Shared Responsibility Payment (Federal) no longer applies.
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Note: Some states have their own individual health insurance mandate, requiring you to have qualifying health coverage or pay a fee with your state taxes for the 2019 plan year. If you live in a state that requires you to have health coverage and you don’t have coverage (or an exemption):
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You may be charged a fee when you file your state taxes.
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You won’t owe a fee on your federal tax return.
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Check with your state or tax preparer to find out if there is a fee for not having health coverage.​
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We are happy to review plan options and provide more details on your specific plan.
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