Affordable Care Act (Marketplace) Coverage Through 8-15-21—This year Marketplace enrollment has been extended to 8-15-21. Since the Affordable Care Act (ACA) began in 2014, Open enrollment has always been 3 months—Nov 1 thru Jan 31 with the “effective date” of the plan ranging from Jan 1 to Mar 1. Due to COVID-19 a Special Enrollment Period (SEP) has been granted to the uninsured to enroll in coverage. After enrollment, coverage will begin the 1st day of the month AFTER the month of enrollment.
Provider access (Doctor/Facility networks)—Will you be able to go your doctor? It is very important to confirm your doctor and local hospital BOTH accepts and is in network for the plan you are considering.
Insurability (being relatively healthy)—For those with few, if any pre-existing health conditions, there could be many more options available outside the “realm” of Affordable Care act plans—many of these options have much lower premiums and deductibles. But remember generally, these plans considers pre-existing conditions, so you need to be “fairly” healthy to consider these plans.
Deductibles and the Max-Out-of-Pocket (MOOP)—It is very important to understand what expenses apply to your MOOP…especially how prescription drugs are treated as it relates to the MOOP.
Small Group (employer plan)—This is becoming one of the best and most creative ways to avoid having to enroll in individual Affordable Care Act plan. And with certain conditions, spouses can qualify as a 2-person group.
This option solves 3 of the issues mentioned above: Provider access, High Deductibles and Insurability. Group plans offer: extensive networks, low deductibles and they do not consider health conditions.