The Individual Mandate of the Affordable Care Act requires that every eligible resident get and keep qualified health insurance. The right to buy insurance does not exist on a year-round basis, rather it has limited periods for sign up and changing plans. The issue of when to get insurance coverage is important. The law requires coverage or a possible tax penalty for the uninsured.
Comparison shopping is an ideal method for finding value in health plans. The comparison shopping method puts the features of greatest importance to the consumer at the center of the search. Enter your zip code above to start shopping for free health insurance quotes online!
Obamacare Open Enrollment Period
The main health care program under Obamacare is the federal Marketplace at healthcare.gov. This is a national platform for residents of a state that failed or refused to open insurance exchanges for their citizens. One must sign up for Marketplace plans during the annual open enrollment period or run the risk of having no insurance. The exceptions to the rule against signups after open enrollment include special enrollments for those with qualifying life events.
Special Enrollment Periods
After open enrollment closes, one must find a qualifying event and request a special enrollment period.
Special enrollment periods are 60-day windows for signing up for new insurance coverage.
The policy recognizes that there are frequent changes in status that require a new opportunity to get health insurance. You must have a qualifying change of status or life event to get a special enrollment period.
Life events are changes in status that require new opportunities t buy insurance. These events make continuing an old policy or continuing uninsured unworkable for public policy purposes. For example, a woman who gives birth should have a chance to cover herself and the infant in the interests of public policy that promotes regular medical care for nursing mothers and infants. Her status has changed from the previous state to one with an infant child or additional child. In a large, diverse population, these life events occur with great frequency, and the law recognizes the need to adjust to them. The state governments and the federal system recognize the below-listed items as qualifying events.
- Moving to a new state
- Loss of coverage as an employee
- loss of coverage as a dependent
- Loss of coverage at age 26
State Exchanges Open Enrollment
State exchanges in 13 states have the same open enrollment dates as the federal marketplace. The states can extend or modify the closing based on circumstances that require additional time. In the past, they have extended the deadline due to weather, systems issues, and overcrowding in the last-minute rush to join.
States also have policies on special enrollment periods and qualifying events. Some states differ from the federal standards in important ways. For example, New York state recognizes pregnancy as a qualifying event for a special enrollment period while the federal government does not.
Medicare Birthday Enrollment
Medicare uses age as the primary qualification along with participation in the program through employee wage deductions and self-employed contributions. One can enroll in the three months before and after the 65th birthday month. This seven-month range avoids penalties for late enrollment.
The federal government operates the programs known as Original Medicare, Medicare Part A, and Medicare Part B.
The below-listed Medicare programs use private insurance companies. While the federal government sets rules and oversees the adequacy of plans, the insurance companies provide the coverage.
- Medicare Advantage provides comprehensive coverage equal to Original Medicare. These private plans can include prescription drug benefits. The Congress created Medicare Part C to provide private sector style approaches to older Americans. The goal was to introduce effective coverage, greater choices, and lower prices.
- Medigap, or Medicare Supplement, offers protection against unpaid portions of Medicare Part B expenses. Medicare part B: Medical Insurance typically leaves a portion of each benefit for the consumer’s account. These charges occur frequently and in the range of twenty percent or more. Over the course of an insurance cycle, the Part B outpatient charges can add to a substantial financial burden for many Americans. Medicare Supplement can pay a large portion of the excess Part B expenses.
- Medicare Part D: Prescription Drugs reduces the costs of prescription drugs. Outpatient care increasingly involves the use of prescription drugs over a long term plan of care. Some drugs have high prices and scarce availability. Prescription drug insurance can reduce the out of pocket expenses for many Medicare subscribers.
Medicaid is Open Year-Round
Medicaid is a joint program of the federal and state governments. Each state administers its Medicaid program under the policies it chooses. State discretion is limited by the conditions of federal assistance which require broad coverage, nondiscrimination, and fair practices.
Medicaid has no limited open season for enrollment. Qualified applicants can get coverage at any time of the year.
The purpose of the program is to provide medical care for those need and financially limited circumstances. Medicaid provides many of the benefits of Marketplace policies. The Affordable care Act requires minimum coverage and essential health benefits from Medicaid providers.
CHIP Is Open Year-Round
The Children’s Health Insurance Program provides protection for infants, young people, and adolescents. Young persons can get coverage up to age 18 in some states.
The CHIP helps families that need medical and dental care. The program has a year-round enrollment policy, and it uses automatic referrals from the Obamacare marketplace and state exchanges.
The CHIP represents a commitment to getting children and young people off to a healthful start in life. Studies show significant relationships between development and regular medical care in children and adolescents.
When can I get government health insurance?
One can get government health insurance at age 65 for Medicare, during the open season and special enrollments for Obamacare, and at any time for Medicaid. Medicare is based on age and physical condition. One can qualify at age 65 or younger if there is a disease in the categories they permit. These include End-Stage Renal Disease and Lou Gehrig’s disease.
Medicaid is open year-round and available to those that qualify on the basis of income limits and need. The CHIP is also open year-round and available for children and young people in need.
Comparison shopping is a tried and proven method for finding high-value health insurance. Consumers can set priorities based on their individual and family circumstances. Even if you don’t qualify for free health insurance from the government, there are options out there. Click here and enter your zip code to explore free quotes based on your budget, need, and location.