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MEDICAL COVERAGE BENEFITS

Individual health insurance is health coverage that is purchased by an individual or family and is not tied to a job or group of policyholders. 

Many people get health insurance through their employers. However, if you do not currently participate in your employer’s health plan, or if your employer doesn’t offer coverage, obtaining individual insurance is a good route to go to ensure that you and your family will receive affordable routine healthcare and will be protected from very high costs in the event of a medical emergency.

Below is a list of some different types of coverage and where you can obtain them:

  • Get on your Parent’s, Spouse’s or Domestic Partner’s Plan – if your spouse or employer has an employer-sponsored plan that is open to family members, consider joining or enrolling your children. The Affordable Care Act (ACA) extended coverage for young adults up to age 26 on plans offering dependent coverage, regardless of their marital or student status.
  • Obtain Insurance through COBRA or State-Sponsored Plans – If you recently left your job or had your hours reduced and were subsequently dropped from employer-based coverage, you may be able to obtain coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). 
  • Obtain Insurance Through Protections Under HIPAA – Under the Health Insurance Portability and Accountability Act (HIPAA), at least one private insurer must sell you a policy if you meet all of the following conditions: you previously had 18 months of coverage without a break for more than 63 days; the last day of your coverage was through your former or current employer; and you do not have COBRA or mini-COBRA option available.
  • Determine Whether you are Eligible for Medicaid or other State Programs – Medicaid provides health coverage for some low-income individuals, including families and children, pregnant women, the elderly, and people with disabilities. Visit www.medicaid.gov to determine whether you are eligible for Medicaid coverage.
  • Obtain insurance in the Individual Market*
  • Shop for coverage using the Health Insurance Marketplace* 

*Under ACA, the federal Annual Open Enrollment for under-65 individual and family plans begins on November 1 and continues through December 15. Anyone can enroll during this time, no questions asked. Coverage begins on January 1.

If you are looking for coverage outside of the Annual Open Enrollment period, you must have had a qualifying event which would create a Special Enrollment Period (SEP). When you have an SEP event, you must enroll in coverage within 60 days after the event occurs. Examples of SEPs include, but are not limited to, loss of group coverage, exhaustion of COBRA, marriage, divorce, moving into the area, etc.

Without a SEP, you must wait until the Annual Open Enrollment to enroll in an individual/Family health insurance plan.

For more information on your coverage options, or for help selecting the best health plan for you, contact Risty Benefits today.

Medicare-Eligible Clients: We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact www.medicare.gov or call 1-800-Medicare to get information on all your plan options.

Did you know?

The true precursor to modern health insurance began in Texas in 1929. Justin Kimball created Blue Cross to allow teachers in Dallas to pay a hospital 50 cents a month and not be charged when, later, they went to that hospital to have children. This was actually pre-payment and not insurance, although some of them probably never had children.

Questions?

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