The Affordable Care Act (also called ACA or Obamacare) set new rules for how insurance companies offer health insurance. Health insurance (also called health coverage or health plan) helps you pay for medical care. Some of the new rules affect what health care services and providers an insurance plan is required to cover.

The Individual Health Insurance options available to you are very different as compared to Group (offered thru an employer) Health Insurance. One very significant change is that you can no longer purchase coverage any time you want to. You are required to purchase coverage during the Open Enrollment Period, which is November 1st through January 31st.  Or you must qualify for a Special Enrollment waiver. The special enrollment period runs from February 1 until October 31st.

To be eligible for special enrollment, you must have experienced a qualifying life event and apply for coverage within 60 days of the event. A qualifying life event can be a change in your life such as a marriage, the birth or adoption of a child, or a move to a new county. It can also arise when you lose essential health coverage because of events such as a job loss. 

Are there Health Insurance Options other than "Affordable Care Act" plans?
Yes there are. There are a number of Health Insurance options available including Short Term Medical, Supplemental, and Telehealth plans. Please contact us to discuss these plans and why they may be the affordable plan that best meets your needs. 

How are premium rates determined?
Five factors can affect Marketplace plan prices: location, age, family size, tobacco use, and plan category. Health status and gender don’t affect pricing. Under the new PPACA health care law, insurance companies can take into account only five variables when setting premium costs.

  1. Age: Older people can be charged up to 3 times more for premiums than younger people.
  2. Geographic location: Where you live has a big effect on your premiums. Competition, local regulation, and cost of living in different areas account for this.
  3. Tobacco Use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco. Currently most insurers in NC and SC charge 20% more.
  4. Individual vs. family enrollment: Insurers can charge more for a plan that covers a spouse and/or dependents.
  5. Plan category: Plans are available in five categories: Bronze, Silver, Gold, Platinum, and catastrophic. The categories reflect how you and the plan share costs. Bronze plans will likely have lower premiums and higher out-of-pocket costs. Platinum plans are likely to have the highest premiums and lowest out-of-pocket costs.

Two factors that CANNOT affect Marketplace plan prices: gender and health history.

In addition, based on your household income, you may qualify for "Tax Credits" to help pay for the cost of Individual Health Insurance. Please contact us to see if you and your family would qualify for assistance paying your premiums. 

Can I still buy individual insurance if I have a very serious preexisting medical condition?
Yes and No. This will be contingent on which type of coverage you want. If you choose an Affordable Care Act (ACA) "Qualified" plan, these plans are "Guaranteed Issue" meaning there are no Health questions, and everyone qualifies regardless of Age, Gender, or Health History. Short Term Medical plans and other "supplemental" Health plans may have "preexisting" limits. Please contact us to discuss your particular situation.