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Questions To Ask When Requesting Health Insurance Quotes

The Open Enrollment Period is coming to an end soon, and if you still haven’t looked into your health insurance options for the new year, now is the time to do so. But we get that picking a plan can be overwhelming because of all the options out there, so we want to give you the inside scoop on finding the best plan for you: your best bet is to work with an insurance agent. They know the ins and outs of health insurance and work with every insurance company, so they can get you the best possible plan. The best part? If you work with an EZ agent, we will compare plans for you for free! So if you’re ready to get started, we’ve got the most important questions to ask when requesting health insurance quotes from your EZ agent.

What Types Of Plans Are Available?

There are a lot of plans – and we mean A LOT – of different plans out there to choose from. There are metal tier plans, HMOs, PPOs, POSs, EPOs, and more. Each plan offers different levels of flexibility, coverage options, and rates; your available options also depend on where you live, so be sure to ask your EZ agent which plans are available in your region. We will gladly go over every single option and discuss the difference between each plan, so we can help you determine which one is right for you and your family.

What Are The Metal Tiers?

Health plans available on the ACA Exchange are separated into four metal tiers. These tiers do not indicate the level of care you will receive; rather, the tiers let you know how much you will pay for care and how much your insurer will pay. The tiers are:

Bronze– Lower monthly premiums, but a higher deductible and copays. You will usually pay an average of 40% of costs of care, and your insurer will pay 60%.
Silver– Moderate monthly premiums and moderate medical costs. You will pay 30%, and your insurer will pay 70%.
Gold– Higher monthly premiums with lower out-of-pocket costs. You will pay 20% and your insurer will pay 80%.
Platinum– Highest monthly premiums and lowest out-of-pocket costs. You will pay 10% and your insurer will pay 90%.

We will be able to go over this in more detail, including what each type of plan will cover and how much you will pay, so you can have a better understanding of how these plans work.

Can I Add Supplemental Insurance?

Dental and vision are considered supplemental insurance plans; some health insurance plans do not offer these, so you will have to ask if they are part of the plan you are looking into. If they are not, we can help you find affordable dental and vision plans.

What is A HDHP & Will It Work For Me?

High deductible health plans are exactly what they sound like: these plans have high deductibles, but in exchange, you will have low affordable monthly premiums. These plans are generally for healthy people who only see the doctor for annual physical exams and do not have any chronic conditions that require constant medical attention, and who will most likely not have to pay their whole deductible. For 2022, the Internal Revenue Service has defined a HDHP as any plan with a deductible of at least $1,400 for an individual, or $2,800 for a family.

How Are Medications Covered?

money made out of medication pills — *Medications are covered differently on plan’s drug formulary, which determines how much your medications cost.*

Figuring out the cost of your prescriptions can be a little complicated since different insurance companies can charge differently for the same drug – some drugs might even be covered differently by the same insurer depending on the plan you choose. Basically, insurers put medications into a drug formulary, which is divided into four tiers:

Tier 1– Inexpensive generic drugs
Tier 2- Brand name drugs and more expensive generic drugs
Tier 3– Non-formulary drugs, generic or brand name
Tier 4- Specialty drugs

To find out which plans cover your medications and how much you will be charged based on their placement in the insurer’s drug formulary, you need to speak with an EZ agent. We will review each plan available in your area and their drug formularies to make sure that your medications are covered, and that they will not cost you an arm and a leg.

What About Out-of-Network Coverage?

Some plans, like HMOs, will not cover out-of-network coverage, but PPO and POS plans do cover out-of-network coverage in case of an emergency. If you travel or visit family in other parts of the country often, you’ll definitely want to consider a plan that covers out-of-network emergencies; otherwise, if you have an accident while away from home, you could be stuck with a bill that you have to pay out-of-pocket.

Do I Need Referrals?

With some plans, you’ll need a referral from your primary care physician (PCP) to see a specialist, like a gastroenterologist or an orthopedic doctor. If you want to skip this step and see a specialist whenever you feel necessary, we can help you find a plan that does not require a referral. You’ll have more flexibility with a plan that doesn’t require referrals, and you won’t have to pay a PCP copay just to get a referral to see a specialist.

There are so many things to think about when looking for a health insurance plan for you and your family. Do you want more flexibility? Supplemental insurance? Cheaper prescriptions? The easiest way to find the right plan for you and get the answers to these questions is to work with an EZ agent. We will compare plans, go over every option, discuss your needs, and help you sign up for the plan you need, all at no cost to you. Our services are completely free, with no hassle and no obligation. Speak to an EZ agent now, before the OEP ends! Get free health insurance quotes by entering your zip code in the bar above, or to speak with a local agent, call 888-350-1890.

Which States Run Their Own Health Insurance Exchanges?

The Open Enrollment Period is almost over: you only have until January 15 to purchase or change your plan! With that being said, though, some states have chosen to extend their deadline; they can do this because, under the Affordable Care Act (ACA), each state can run its own health insurance exchange, or Marketplace, in which people can shop for health insurance.

This state-based Marketplace is a government agency that is created and maintained by the state, and that offers subsidized ACA plans for residents of that state. You can buy a plan from your state’s Marketplace, or you have the option of buying off-exchange coverage from an insurance company; if you do this, you will not get premium subsidies and cost-sharing reductions– those are only available through the exchange. So which states run their own Marketplaces and what does that mean for you?

State-Run Vs. Federally Run Exchanges

When the ACA was passed in 2010, it provided funding and laid out rules for states to be able to establish their own exchanges; if states chose not to have their own exchange, the federal government would then step in and offer insurance for that state’s residents. So, many states chose to do it themselves so they could have more control of their Marketplace, and make it more profitable and sustainable. The federally run exchange, accessible through Healthcare.gov, is used in 36 states. The other 14 states (and Washington D.C.) have their own exchanges.

States With Their Own Exchanges:

California (Covered California)
- Deadline is January 31
Colorado (Connect for Health Colorado)
Connecticut (Access Health CT)
District of Columbia (DC Health Link)
Idaho (Your Health Idaho)
Maryland (Maryland Health Connection)
Massachusetts (Massachusetts Health Connector)
- Deadline is January 23
Minnesota (MNsure)
Nevada (Nevada Health Link)
New Jersey (Get Covered NJ)
- Deadline is January 31
New York (New York State of Health)
Pennsylvania (Pennie)
Rhode Island (HealthSource RI)
- Deadline is January 31
Vermont (Vermont Health Connect)
Washington (Washington Healthplanfinder)

If you live in a state that has its own exchange, your health insurance plan options and prices might be a little different than if you only have the option of using Healthcare.gov or going off-exchange. In addition, depending on where you live, your OEP might be extended! But just because your state is in control of the Marketplace, that doesn’t mean you can’t find a great affordable ACA-compliant health insurance plan that is right for you by working with an EZ agent.

Looking For Insurance?

The best way to get the right plan for you and your needs is by working with a licensed health insurance agent. At EZ, our agents are highly trained and work with the top-rated insurance companies in the nation, in every state! We will connect you with a local agent who will go over your medical needs and budget, and sift through all the available plans in minutes. We’ll quickly find you a plan that will save you money – especially now, with the premium subsidies President Biden has extended to all Americans. You could save hundreds of dollars a year! No hassle and no obligation. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890.

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.

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:

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.

Health Insurance Open Enrollment FAQ

The Open Enrollment Period for health insurance is a very important time, when you can change or enroll in a health insurance plan for coverage beginning the following year. It runs from November 1 to December 15, and is the only time during the year when you can purchase a plan, unless you qualify for a Special Enrollment Period. To better prepare you for the Open Enrollment Period, including what to expect and how to find a great plan, we’ve answered some FAQ below.

When Is The Annual Open Enrollment Period?

calendar with the date on november 1 — *Health insurance Open Enrollment begins on November 1st every year.*

The Open Enrollment Period is the one time of the year that you can buy or change your health insurance; if you do not buy health insurance during the Open Enrollment Period, you will have to wait until the following year to do so, unless you experience a qualifying life event.

The Federal Open Enrollment Period starts on November 1st and ends December 15, which gives you just about six weeks to choose a health insurance plan and sign up for one. However, some states have permanently extended their Open Enrollment Period until January 15th or 31st, with coverage beginning February 1st.

Am I Eligible To Enroll In Marketplace Health Insurance?

To be eligible to enroll in ACA Marketplace health insurance, you must:

Be between the ages of 18 and 64
Live in the United States
Be a U.S. citizen
Not currently be incarcerated

envelope in a blue circle — Be sure to review the ANOC letter you will receive about your current plan’s coverage for next year.

What Changes Can I Make During Open Enrollment?

If you currently have a health insurance plan, you will receive an annual notice of change (ANOC) letter in the mail prior to Open Enrollment; you’ll need to carefully review this because there might be changes being made to the price or coverage of your plan. But if your plan is not changing and you are happy with it, you will be automatically re-enrolled for next year.

If you are unhappy with your health insurance plan, you can switch to a new one, but you will have to review all of the plans in your area, including new ones that might have been added. If you don’t review plans in your area during the Open Enrollment Period, you won’t know if there is a better plan for you; the best way to do this is by working with one of EZ’s licensed local agents, who can compare plans easily for you in minutes.

What If I Miss The Open Enrollment Period?

If you miss the Open Enrollment Period, your choices will be very limited until next year’s Open Enrollment Period, unless you qualify for a Special Enrollment Period. To qualify for a Special Enrollment Period (SEP), you’ll need to have experienced one of the following qualifying life events:

Getting married or divorced
Death of a spouse or policyholder
The birth or adoption of a child
Loss of health insurance coverage
Moving to a new area where the health plans are different from what you currently have

If you are looking for health insurance temporarily until the next Open Enrollment Period, you have the option of short-term health insurance, which will cover you for up to 36 months, but this type of plan has limited coverage.

Can I Afford Health Insurance?

The first thing you should do if you’re looking to save money is work with an agent who can compare plans for you and find one that fits your budget. Next, check to see if you qualify for subsidies, such as premium tax credits and cost-sharing subsidies. Premium subsidies are available in every state, and help make health insurance more affordable. Eligibility for subsidies is based on your household income; it’s definitely worth checking to see if you qualify, since President Biden recently extended premium subsidies to millions of Americans, making them easier to get, even for those with an income of 400% of the federal poverty level or higher.

How Do I Find A Plan?

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 license agent call 888-350-1890.

Preparing For Health Insurance Open Enrollment: Employer Checklist for Open Enrollment

Open Enrollment for health insurance has begun. This period gives employers and employees the opportunity to change their benefit options, and many companies use this time to review their employees’ health insurance plans to see if they can find ways to save money or improve coverage. The opportunity for business owners to save money during Open Enrollment is especially important this year because the coronavirus has hit many companies hard financially. Now is the time to speak to an EZ agent to see if you should renew your current plan or switch to a more affordable plan that offers just as many benefits.

As you review your options, you also have to be aware of any legal changes affecting the design and administration of your current plan or any other plan you choose. Go through the following checklist, share it with your employees, and use it to help you choose your plan for the coming year.

change written on many freen arrow signs pointing in different directions. — *Healthcare plans change every year, including the price and coverage, so you need to be aware to be better prepared.*

Plan Design Changes

Healthcare plans and the rules surrounding them change every year. The cost of your plan may go up, so you need to be aware of changes to your costs. But you also need to be aware of changes to certain limits in your plan. Some changes to know for 2021 include:

Affordable Care Act (ACA) affordability standard– The affordability percentage for 2021 is 9.83%. Employer-sponsored coverage for next year’s plan will be considered affordable under the employer shared responsibility rule if the employee’s required contribution for self-only coverage does not exceed 9.83% of the employee’s household income for the tax year.
Out-of-pocket maximum– The annual out-of-pocket maximum limit for 2021 is $8,550 for self-only coverage and $17,100 for family coverage.
FSA contribution limit: This has not been announced yet, so watch for IRS guidance on the FSA contribution limit for the 2021 plan year.
High deductible health plan (HDHP) and health savings account (HSA) rules for 2021:
- HSA contribution limits: $3,600 for individuals and $7,200 for families
- HDHP minimum deductible: $1,400 for individuals and $2,800 for families
- HDHP out-of-pocket-maximum: $7,000 for individuals and $14,000 for families

Make sure to confirm that your plan’s out-of-pocket maximum complies with the ACA’s limits for next year. If you offer a HDHP, make sure that the plan’s deductible and out-of-pocket maximum are also in compliance with next year’s rules. Remember to communicate these changes to your employees.

Notices To Pass On To Employees

You should provide certain benefits notices to your employees during the Open Enrollment Period. Benefit notices that you should review and provide to your employees include:

Summary of Benefits and Coverage– The ACA requires healthcare plans and health insurance issuers to provide a summary of benefits and coverage to enrollees. This has to be given to your employees who enroll or re-enroll during Open Enrollment.
Summary Plan Description (SPD)– Plan administrators have to provide a SPD to new participants within 90 days after plan coverage begins. In addition, any changes that are made to the plan should be communicated to employees in an updated SPD booklet.
COBRA General Notice– Group health plan administrators have to provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. It can be included in the SPD.
Grandfathered Plan Notice– If you have a grandfathered plan, then make sure that you provide any information about the plan’s status and any changes to the plan.
Children’s Health Insurance Program (CHIP) Notice– Group health plans that cover residents in a state that provides assistance subsidies under a Medicaid plan or CHIP have to send an annual notice about the available assistance to all employees residing in that state.
Notice of Patient Protections– This notice needs to be provided if you are offering non-grandfathered group health plans that require designation of a participating primary care provider. If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice.
Individual coverage HRA (ICHRA)– This applies to employers who sponsor ICHRAs for specific classes of employees, or all employees. You must provide the written notice to each participant at least 90 days before the beginning of each plan year.
HIPAA Privacy Notice– Employers with self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Wellness Program Notices- There are 2 notices that you will need to provide employees if you offer a workplace wellness program:
- HIPAA Wellness Program Notice– HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards.
- Americans with Disabilities Act (ADA) Wellness Program Notice– Employers with 15 or more employees are subject to the ADA. Wellness programs that include health-related questions or medical exams must comply with the ADA’s requirements, including an employee notice requirement.

shopping cart with money held in a paperclip inside of it. — *Comparing plans with an EZ agent can help you save hundreds of dollars a year!*

Finding An Affordable Plan

Whether you are considering renewing your current group plan, or finding a new plan or insurance company to work with, you will have to do some researching and comparing. There are hundreds of group insurance plans to compare in order to find the one that best suits you and your employees. By combing through these plans, you will be able to save hundreds, and maybe even thousands of dollars a year! The first step in figuring out what kind of plan to look for is to conduct an employee health survey.

Next, you should speak to an EZ agent. It can be time consuming to sit down and compare plans, and with Open Enrollment coming to an end soon, the whole process can become overwhelming. Running a business means that you have a lot on your plate, so let EZ.Insure do all the work for you. You can speak to one of our agents free of charge. They will ask you questions regarding your budget and employees, and will then begin comparing quotes. EZ will present you with the best option that will offer the most benefits and savings. To get instant quotes, simply enter your zip code in the bar above, or to speak directly to a licensed agent, call 888-998-2027.

Tag: health insurance help