Can You Be Denied Coverage During the Open Enrollment Period?

The ACA Open Enrollment Period is the only time of the year when everyone can enroll in a health insurance plan. But can literally anyone enroll, or is there any reason you can be denied coverage during this time? The short answer to this question is no: the whole idea behind the creation of the Affordable Care Act (ACA) was to make sure everyone could get insurance. But being allowed to get insurance is different from insurance being accessible to all – so how does the ACA remove all the barriers to getting insurance and make everyone truly able to get the plan they need? 

What The ACA Has Done for Millions

Before the ACA was passed in 2010, you could have been denied a health insurance plan simply because you had a pre-existing condition. That meant a huge amount of Americans were unable to find affordable health insurance: approximately 43% of U.S. households report having pre-existing conditions. And indeed, health insurance was out of reach for many before 2010: when the ACA went into effect approximately 46.5 million people, or 17.8% of the total nonelderly population, were uninsured. 

bar graph going upward with a green arrow moving upward

But the ACA, with its Patients’ Bill of Rights that prohibits insurers from discriminating based on pre-existing conditions or revoking your coverage because of an unintentional mistake on an application, changed everything. 31 million people have enrolled in health insurance plans through the Affordable Care Act since it was enacted, and that is a huge accomplishment! But there has been criticism over the years that health insurance, while available to everyone, was still not accessible to everyone – but that has all changed. 

President Biden’s American Rescue Plan

illustration of a cell phone with a money sign on it and dollar bills behind it
The American Rescue Plan Act has offered more people the ability to save more money on their health insurance premiums.

 save afcad

Earlier this year, President Biden passed the American Rescue Plan (ARP), which has made health insurance far more affordable for far more people. It extended premium tax credits to more Americans by allowing people who earn over 400% of the federal poverty level to receive subsidies to purchase health insurance through the ACA Marketplace; it also requires that Americans pay no more than 8.5% of their income on health insurance premiums, and provides a larger tax credit to people who already receive financial assistance.

What all of this means is cheaper premiums! For most people, premiums will be at least $50 per month cheaper, while some people might pay $0 in premiums. With the new law:

  • An individual making $19,000 or less per year will not have to pay a monthly premium for health insurance. 
  • Couples who earn less than $70,000 together will save $1,000 per month on their health insurance monthly premiums. 
  • A family of 4 with an income of $90,000 will pay about $200 less in health insurance premiums.

The bottom line is you can never be denied health insurance coverage during the Open Enrollment Period; not only that, but insurance is now affordable for everyone, so there is no reason you can’t get a plan that is right for you. It is important to note, though, that the Open Enrollment Period is the only time you will be able to get coverage: if you miss the OEP, you will have to wait until next year’s OEP, unless you qualify for a Special Enrollment Period. Don’t let this period pass you by – it’s the perfect (and only) time to get a great affordable health insurance plan!

Need Help?

If you have any further questions, or need help finding a plan during the Open Enrollment Period, an EZ agent can help you. We will provide you with a local licensed agent who will search all available plans in your area and find the best one for your medical and financial needs. We will also double check to see if you qualify for any subsidies to save you even more money. All of our services are done in minutes and at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local licensed agent call 888-350-1890.

What Happens If I Don’t Do Anything During The Open Enrollment Period?

The ACA Open Enrollment Period only comes around once a year, usually lasting from November 1- December 15, although this year the deadline has been extended to January 15. During this period, you can enroll in a new health insurance plan, or make changes to your current  plan. If you’re happy with your current plan, though, you might opt to not do anything at all during the Open Enrollment Period – but not doing anything can have certain consequences, depending on your situation.

You Could Get Stuck With Your Current Plan

This might not necessarily be a bad thing if you are happy with your current plan, but if your plan isn’t quite right for you, you will unfortunately be stuck with it until the next Open Enrollment Period opens up again.

You’ll Miss The Opportunity To Change Your Plan

If you don’t take the opportunity to review your current plan and do nothing during the Open Enrollment Period, you won’t be able to change your plan. What this really means is that your health insurance might:man looking at laptop frustrated while on the phone

  • Not provide enough coverage for the following year, which will cost you money.
  • Have too much coverage that you don’t need, essentially leaving you to pay for insurance that you don’t need.
  • Be too expensive. If you don’t change your plan during the OEP, you’ll be stuck with the rise in rates and costs for the following year. 

Options Are Limited Afterwards

If you don’t have health insurance and are looking to enroll in a plan, but you do nothing during the Open Enrollment Period, you won’t be able to get a Marketplace or exchange health insurance plan – in other words, you won’t be able to get an ACA-compliant health plan. With that being said, you do have other options even if you miss the OEP, but you should be aware that they are very limited. For example, you can opt to get a short-term health insurance plan that covers the essentials and nothing more; this type of insurance is temporary and not ideal for those who require more comprehensive coverage, or have health conditions. Short term plans are not guaranteed issue, meaning they do not cover pre-existing conditions.

You Will Need To Qualify For an SEP

The only way to get an affordable health insurance plan that is ACA-compliant outside of the OEP is to qualify for a Special Enrollment Period, or SEP. A Special Enrollment Period is only available to those who have a qualifying life event, including: movers with boxes and a truck and houses in the background

  • Change in residence (moving to a different zip code or county)
  • Change in household size (having a baby or adopting a child, getting married, or getting divorced)
  • Loss of health insurance (losing employment, turning 26 and getting kicked off of a parent’s plan, or a death in the family)
  • Changes in income

Don’t Do Nothing…

Compare plans! There’s no harm in comparing plans and seeing your options before the Open Enrollment Period ends. But we get that it can be a headache to try and research all the different plans around, so we’re here to help! Our highly trained agents will take the time to talk with you and thoroughly explain all of your options. Once you are ready to enroll, they will search through all the plans in your area and find the right plan for you, making sure the plan fits your needs and budget. EZ always provides you with your own personal agent, so there’s never any need to worry about bouncing around from agent to agent or getting hassled by endless sales calls. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 888-350-1890.

Find Out Which Premium Tax Credits You Qualify For This Open Enrollment Period

In case you haven’t heard, earlier this year, President Biden passed the American Rescue Plan Act (ARP), which extended health insurance premium tax credits to more Americans. What this means is that you can now qualify for premium tax credits that you probably couldn’t have before. So, how much can you save exactly? Well, to find out how much you and your family can save on health insurance premiums, speak with a licensed EZ agent. Our agents will make sure to find the most savings for you – you could save anywhere from $50-$1000 a month!

What Is The Premium Tax Credit?

gold money signs with a green background
Premium tax credits help you pay for a portion of your monthly insurance premiums, so you can save more money.

In 2014, the Affordable Care Act (ACA) established the premium tax credit so that individuals or families with low or moderate incomes could afford health insurance on the Health Insurance Marketplace. Premium tax credits help you pay for a portion of your monthly insurance premiums; you can choose to have payments of the premium tax credit go directly to insurers to pay a share of your monthly insurance premiums, or wait until you file taxes to claim them. 

Do You Qualify?

Since the passage of Biden’s American Rescue Plan Act, premium tax credits are now available to individuals or families with incomes between the federal poverty line and 400% of the federal poverty line. It also requires that Americans pay no more than 8.5% of their income on health insurance premiums, and provides a larger tax credit to people who already receive financial assistance. To qualify:

  • You must prove you do not have access to an affordable employer-sponsored plan.
  • You must prove you are not eligible for Medicare, Medicaid, or TRICARE.
  • You cannot be claimed as a dependent by another taxpayer.
  • You must file a joint federal income tax return if you are married; you cannot file a married filing separately tax return (unless you’re a victim of domestic abuse or spousal abandonment).
  • You must have a household income that falls within a certain amount.

It is important to note that you will not be eligible for the premium tax credit if you buy a plan outside of the Marketplace or exchange.

How Much Will You Save With An EZ Agent?

Our agents are highly trained and work with the top-rated insurance companies in the nation, making it easier for them to compare plans and find ways to save you the most money. Between the premium tax credits and your agent’s comparison shopping, you can expect to see a drop in premiums of $50 a month or more! With the new law:fifty dollar bill in a jean pocket.

  • An individual making $19,000 or less will not have to pay a monthly premium for health insurance. 
  • Couples who earn more than $70,000 together will save $1,000 per month on their health insurance monthly premiums. 
  • A family of 4 with an income of $90,000 will pay about $200 less in health insurance premiums. 

If you buy a health insurance plan during the Open Enrollment Period, or switch plans, you will be able to receive the tax credits. So, what better time than now to find an affordable plan and save money? Comparing plans is the best way to find an affordable plan that provides the right level of coverage for you, but before you start doing the work of comparing on your own, come to EZ. We will make the process quicker and easier by comparing available plans in your area in minutes. Our licensed agents work with all the top-rated insurance companies in the nation and can go over your budget and needs, and find the best plan for you and your family. We compare plans and offer guidance at no cost to you. To get free quotes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-350-1890.

How Will Your Health Insurance Plan Change in 2022?

All health insurance plans change every year: you’ve probably noticed that your prices go up, or that different things are covered from year to year. But sometimes, the rules surrounding health insurance plans also change, as they are set to in 2022. Next year, aside from the newly extended Open Enrollment Period and the Special Enrollment Period for low-income  applicants, there will also be some updated rules and regulations for the ACA and the Marketplaces put into a document called the Notice of Benefit and Payment Parameters. Knowing what changes are coming next year will help you make an informed decision about your health insurance plan during the Open Enrollment Period.

Out-of-Pocket Maximum Capped

hundred dollar bills sticking out of a pocket
New out-of-pocket maximums for 2022 are $8,700 for individuals, and $17,400 for a family.

For 2022 health coverage, the out-of-pocket maximum, or the most you have to pay for covered services in a plan year, will be $8,700 for individuals, and $17,400 for a family. The only plans that this does not apply to are grandmothered or grandfathered plans, as well as short-term plans and fixed indemnity plans. 

The proposed out-of-pocket cap for 2022 was originally $9,100 for individuals and $18,200 for families, but this was changed after the Department of Health and Human Services (HHS) listened to public comments. The HHS decided that they would lower the limits, with some health plans having out-of-pocket limits well below $8,700 for individuals. These plans include employer-based health plans and metal tiered plans for family and individuals. 

And if you qualify for cost-sharing reductions, your maximum out-of-pocket limits will be even lower. You can receive cost-sharing reductions if your household income is no more than 250% of the poverty level and you select a Silver plan.

The out-of-pocket maximum for you plan depends on your household income; the new income levels and limits for 2022 are:

  • If your income is between 100% and 200% of the poverty level, your out-of-pocket maximum will be approximately $2,900 for an individual and $5,800 for a family.
  • If your income is above 200% but no more than 250% of the poverty level, your out-of-pocket maximum will be approximately $6,950 for an individual and $13,900 for a family.

A New Special Enrollment Period

If you lose your health insurance coverage because of a job loss, you qualify for a Special Enrollment Period (SEP), which allows you to buy a health insurance plan outside of the Open Enrollment Period. But what if you are on a government- or employer-sponsored COBRA plan? What happens when that plan ends? Well, if your subsidy ended on or after September 30, 2021, a SEP will open up to you. That means you now have the option to transition to a plan on the exchange after your subsidy ends; you can also receive the ACA’s premium tax credits if you are eligible based on President Biden’s new subsidy extensions.

If you need more information on the changes coming to plans for next year, or need help finding a plan during the Open Enrollment Period, an EZ agent can help you. We will provide you with a local licensed agent who will search all available plans in your area and find the best one for your medical and financial needs. We will also double check to see if you qualify for any subsidies to save you even more money. All of our services are done in minutes and at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local licensed agent call 888-350-1890.

Does Your Health Insurance Plan Cover Your Basic Needs? Find Out If It Is ACA-Compliant

When former President Obama came into office, one of his top priorities was to make sure all Americans were insured, and thus the Affordable Care Act (ACA), or Obamacare, was enacted in March 2010. The ACA has not only made health insurance easier to get for millions of Americans, but it has also meant that now all health insurance plans must cover certain basic needs, as long as they are ACA-compliant. Knowing if your plan is ACA-compliant or non-compliant will help you to get the most out of your health insurance plan, and to know if you need to switch your plan to one that is compliant.

What Does ACA-Compliant Mean?

ACA-compliant health insurance plans are known as qualified Major Medical health plans, and  cover the 10 essential health benefits with no annual or lifetime coverage maximums. These essential benefits include: illustration of a man laying in a hospital bed with a doctor standing next to him

  1. Hospitalization
  2. Ambulatory services (visits to doctors and other healthcare professionals and outpatient hospital care)
  3. Emergency services
  4. Maternity and newborn care
  5. Services to treat mental health disorders and problems with substance abuse
  6. Prescription drugs
  7. Lab tests
  8. Preventive services, including things like contraception, blood pressure screening, breast cancer screening, colorectal cancer screening, obesity screening and counseling, tobacco use counseling and interventions, and breastfeeding counseling
  9. Pediatric services for children, including dental and vision care
  10. Rehabilitative and habilitative services

ACA-compliant plans are also guaranteed issue during the open enrollment period, which means that any pre-existing conditions will not play a role in your eligibility for a health insurance plan.

Non-Compliant Plans

illustration of a gray clock without numbers
Short term plans are not ACA-compliant, but are cheaper and temporary for when you can sign up for an ACA-compliant plan.

Other types of health plans that do not cover the 10 essential benefits, sometimes called traditional plans, are considered non-compliant with the ACA. Non-compliant plans include short-term health insurance, fixed indemnity plans, and healthcare sharing ministry plans. These types of plans do not have to abide by the ACA’s consumer protections and are exempt from federal regulations.

Of non-compliant plans, short-term health plans are probably the most commonly purchased, because they are generally much cheaper than ACA-compliant plans. They provide temporary coverage when you are not eligible for a major medical plan or are waiting for coverage to start. Unlike ACA-compliant health insurance plans, these plans can use your pre-existing conditions against you; short-term policies were created for healthier individuals who need some sort of emergency coverage for a short amount of time, so they only cover the basics. Therefore, people with pre-existing conditions, or who are in need of medical care should not consider a short-term health plan.

Looking For More Coverage?

ACA-compliant plans offer more coverage, and thanks to Biden’s American Rescue Plan Act, premium subsidies have been extended to more people, so everyone can save money on health insurance. Before you start doing the work of comparing plans on your own, come to EZ: we will make the process quicker and easier by comparing available plans in your area in minutes. Our licensed agents work with all the top-rated insurance companies in the nation and can go over your budget and needs, and find the best plan for you and your family. We compare plans and offer guidance at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-350-1890.

Speak with an agent today!
Get Quotes