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Qualify For A Special Enrollment Period? Find Out What Documents You Need

The Affordable Care Act (ACA) changed a lot of things about the way healthcare works in the U.S. One of the changes it made was to create an open enrollment period for everyone shopping for a health insurance policy on the Marketplace. In most cases, you can only enroll in a health insurance plan, or change your plan, during this period, which runs from November 1 to December 15. If you miss open enrollment, then you cannot enroll in a plan, unless you have what is known as a qualifying life event. Experiencing one of these life events opens up a Special Enrollment Period (SEP) for you, meaning that you will be able to sign up for a new plan. Different types of qualifying life events require you to produce different documentation proving your eligibility for a SEP.

Qualifying Life Events

illustration of people moving with a truck and boxes and people carrying boxes. — One of the qualifying life events is moving to another county or state.

A Special Enrollment Period is only available to those who have a qualifying life event, including:

Change in residence (moving to 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 death in the family.)
Changes in income

The Different Documents Required

If you lose health insurance or need a new plan, and you want to use a Special Enrollment Period to shop for a new plan, you will generally be notified of what documents are needed in your Eligibility Results Notice. You will then have 30 days to submit these documents by mail or by uploading them to healthcare.gov. There are different forms of documentation required depending on the life event.

For change in residence you will need to have moved in the past 60 days and have had health insurance at least one day in the 60 days before your move. To prove this, you will need to submit:

Documents proving that you moved, such as rental agreements, mortgage bills, or utility bills, as well as documents proving your new address and the date of your move.
Documents proving you had insurance prior to your move, such as a letter from an insurance company or employer.

For change in household size you will need:

Legal or government-issued documents of an adoption or a birth certificate
Marriage license or certificate.
Divorce certificate.

For loss of health insurance you must show that you had qualifying health insurance coverage in the past 60 days and that you will be losing coverage in the next 60 days. You will need:

A letter from your insurance company showing termination date.
A loss of health insurance coverage letter from your employer.

For change in income, you will need:

Proof of a reduction in income which makes your current plan unaffordable for you, such as a past and current paycheck or W-2 forms.

Special Enrollment Period Coverage

After you submit your documentation and prove that you qualify for a Special Enrollment Period, you can get on the Marketplace and pick a health insurance plan. Coverage for your new plan will either begin the first day of the month after you pick your plan or the first day of the second month after you pick your plan, depending on the qualifying life event. Some types of coverage will be active sooner than others; for example, if you have a baby or adopt a child, coverage is retroactive to the date of the birth or adoption, as long as you pick a plan within 60 days.

Need Help?

If you still have questions on how this all works, contact one of our agents. Our highly trained agents will take the time to talk with you, and will go over all of your documents for you as well as 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.

Why Do Health Insurance Premiums Go Up Every Year?

Health insurance is worth the cost. Paying your monthly premiums can mean the difference between having your medical emergencies or chronic conditions covered, or being hit with huge medical bills and possibly even bankruptcy. As with many things that are worth having, healthcare doesn’t come cheap, and almost every year health insurance companies raise insurance premiums and other rates. Multiple factors go into how insurance companies calculate your premiums, and there are multiple reasons that rate rise.

How Premiums Are Calculated

different analytics with calculator and graphs and a hand holding a pen. — *Insurance companies will first develop a profile of all their consumers to calculate costs.*

To determine how much they will charge for premiums, insurance companies have to figure out how much it will cost them to cover their customers’ healthcare costs, plus how much it will cost them to run their business. Your premiums will go towards both of these costs. But while they generally know how much their administrative costs (such as employee salaries) will be, they need to calculate how much it will cost to pay for their customers’ healthcare needs. To do this, an insurance company will first develop a profile of all their consumers. Then they figure out how much each patient group will cost to cover, factoring in doctor visits, vaccines, and any future medical expenses.

For example, insurance companies might group women in their late 50s and 60s together, and take into account their need for mammograms and yearly checkups with lab tests. They will also consider that older women might need medications for cholesterol or heart problems, might possibly need surgeries, or have accidents. They do these calculations for all patient groups. After all the calculations are complete, health insurance companies will multiply these costs by the number of patients that they are insuring in each profile group and estimate how much costs will be.

Ultimately, your health insurance premiums will be calculated based on your profile group. Your insurance company will look at:

Your age– the older you are, the higher your premium.
If you or your spouse smokes– if you are a regular smoker, or were one within the last 12 months, an insurance company can increase your premium rate. Some companies charge a tobacco surcharge, which can be as high as 50%.
How many children you have to insure and their ages– health insurance companies take into consideration your children’s ages and account for things like stitches, falls, and sports injuries that they may need care for as they grow.
Your location– the more health insurance companies there are competing for business in your area, the lower your premiums will be.

Why Premiums Go Up

When your insurance rates go up, inflation is usually the culprit. Recent rises, though, have been due to other factors. One of these factors is that, because of advances in medicine and technology, people are living longer now than in the past. Not only are there more people to cover, but these people may be older and more in need of medical care.

caucasian mans hand holding a prescription pill bottle pouring meds into his hand — *People who receive treatment and live longer consume more healthcare dollars.*

People who receive treatment and live longer consume more healthcare dollars, meaning that everyone else has to throw more money into the pot to help insurance companies cover costs for older people. In addition, while the ACA’s rule that insurance companies cannot turn someone down due to pre-existing conditions was great for expanding coverage, it also meant that more people with ongoing health issues joined the insurance pool.

Recent rate raises are not only due to who is being covered, but also how insurance companies cover their costs. The government had been supplying subsidies to insurers to help reduce their costs and these subsidies are ending. Because insurance companies will have to make up the difference, they have been raising premiums by 4-7%.

How You Can Lower Your Premiums

You should review your coverage every year during the health insurance open enrollment period. Calculate the cost of premiums, copays, and deductibles and see if you could save money with another plan. Also check for any tax incentives that can help you save money.

If you are relatively healthy, and under 30 or in need of financial assistance, then a catastrophic plan might work best for you. These plans have high deductibles and low monthly premiums. If you need a more comprehensive plan, there might be one in your area that will provide the right coverage at a better price than you’re paying now.

You could be saving hundreds of dollars just by switching to a different plan. When you’re ready to compare all the health insurance options in your area, EZ.Insure is here to make the process quick and easy. We go over all available plans and direct you to a quality plan that will not only cover your needs, but also save you more money than your current plan. Our trained licensed agents will do all the work for you, for free. No need to worry or stress yourself out researching and comparing. To get your free quotes, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Mental Health Issues On The Rise

Mental illness does not discriminate. It affects people of all ages, genders, ethnicities, and socio-economic classes. Health insurance claims for the treatment of depression, anxiety, and other mental disorders have been steadily rising over the years. Recent job losses and stay-at-home orders have made things even worse, with federal agencies and experts warning that a wave of depression, substance abuse, PTSD, and suicide is on its way. Our already underfunded mental health system is at risk of being overwhelmed.

“If we don’t do something about it now, people are going to be suffering from these mental-health impacts for years to come,” said Paul Gionfriddo, president of the advocacy group Mental Health America. “That could further harm the economy as stress and anxiety debilitate some workers and further strain the medical system as people go to emergency rooms with panic attacks, overdoses and depression.”

High Numbers Among Young Adults & Adolescents

While mental health claims among all Americans have been going up, data reported by FAIR health, a nonprofit database of more than 28 billion private healthcare claim records, shows that they are shockingly high among young adults and adolescents, Between 2007 and 2017, mental health claims relating to depression and anxiety in young people were especially high.

In 2007, young people accounted for 15% of all claims tied to serious depression. By 2017, they accounted for 23%. Claims for anxiety also grew more common among young people. Between 2007 and 2017, claim lines for generalized anxiety disorder rose 441% among young people ages 19-22. The report also found that behavioral health diagnoses rose 108% from 2007 to 2017.

Suicide Numbers Rising

Suicide rates are also on the rise, with many worried that an increase in mental health issues combined with our current stressful environment could make things worse. A report issued by the CDC found that suicides are up 30% since 1999, and only half of those who died were diagnosed with a mental health disorder prior to their deaths. Unfortunately, many people suffer in silence, and added stresses such as job loss, or relationship, financial, or health problems, can lead to disastrous consequences.

Meadows Mental Health Policy Institute, a Texas nonprofit, created models estimating that if unemployment rates continue to rise to a level similar to the Great Recession, then an additional 4,000 people could die by suicide and an additional 4,800 could die from drug overdoses.

Mental Health Coverage

two men sitting down, one man with a hand on his chin and the other man with his hands on his head. — *All ACA-approved plans must cover behavioral health treatment, such as psychotherapy and counseling.*

Some experts point out that it’s unclear whether more people are suffering from mental illnesses, or whether we’re getting better at talking about it, recognizing it, and treating it. According to Dr. Stephen Strakowski, a psychiatrist at the University of Texas at Austin’s medical school, “It’s very hard to disentangle [increased prevalence] from increased recognition, more people accessing care, and people being willing to fill out forms more honestly.”

Research shows that people who need mental health care are more likely to get it now than they were at any time in the past, but things are not perfect. There are still many people who aren’t getting the help they need because they don’t have mental health insurance coverage. Fortunately, as of 2014, the ACA requires all Marketplace healthcare plans to cover mental health and substance abuse services.

All ACA-approved plans must cover:

Behavioral health treatment, such as psychotherapy and counseling
Mental and behavioral health inpatient services
Substance use/abuse disorder treatment

Employer-based health insurance, Medicaid and Medicare all offer mental health and substance abuse coverage. It is important that people are encouraged to use this coverage to get screened for suicidal thoughts, to treat any underlying mental conditions, and to access therapy. Seeking help makes a difference.

If you or someone you know is showing warning signs of suicide, help is one call away. For free 24/7 crisis support:

Call the National Suicide Prevention Lifeline: 1-800-273-8255.
Text Crisis Text Line: Text HOME to 741741
Call Substance Abuse and Mental Health Services Administration: 1-800-662-4357

Can Your Health Insurance Company Drop You?

Insurance companies are businesses, and, like most businesses, they have terms and conditions of service. It is possible for your health insurance to legally drop you, but only under certain circumstances. If this happens to you, don’t worry! EZ.Insure will help you find a new plan, for free. We know that you have a lot on your plate and might be feeling overwhelmed, so we will take that weight off your shoulders and help you to get back on your feet.

Reasons You Can Be Dropped

persons head with a mask on in a circle with the word "fraud" underneath it — *Insurance fraud is one of the reasons that your health insurance company can drop you.*

Insurance companies cannot drop you for any reason; there needs to be just cause. Here are some circumstances when you can be legally dropped:

Insurance Fraud– If you misuse your insurance policy in any way, then you have broken your contract with the company. Fraud can include faking your identity, or filing false claims.
Failure To Pay– Obviously, if you fail to pay your premiums, then you will be in breach of your contract with the insurance company. If you have employer-based insurance that is not automatically deducted from your paycheck, then make sure to pay your premiums on time. If you are lucky, you will have a grace period for unpaid premiums, although most insurance companies do not offer this.
Losing/Quitting Your Job – If you receive your health insurance through an employer, and lose your job, then your health insurance company has a right to drop you. You also forfeit your coverage if you voluntarily leave your job.

While some people may think that you can get denied for filing too many claims, that is a myth. As long as your claims are legitimate, then you don’t have to worry. Health insurance companies in the U.S. are regulated by many laws on both the state and federal levels, so you can be sure that you won’t lose coverage just for making claims on your policy.

picture with a road and 2 arrows poiting to an orange box with possibility written above it — *EZ will find you an insurance plan after your company drops you. You have other possibilities.*

There Is Hope

If you do end up losing your health insurance, don’t worry, you have options, and time. When a health insurance company drops you, they must give you 30 day’s notice before terminating your plan. You also qualify for a special enrollment period when you lose health insurance, so take this time to compare other plans and sign up for a new one. If your plan was employer-based, then check to see if your employer offers COBRA plans to temporarily replace your old plan.

Finding a plan can be overwhelming, especially after losing coverage, but we’re here to help. If you are lost, then EZ will provide you with a personal agent who will compare all the available options in your area, for free. Our highly trained agents will listen to your healthcare needs and budget, and advise you on which plan checks all of your boxes. To get free instant quotes on all plans, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890. No hassle, no obligation.

Divorce & Health Insurance

Going through a divorce can be one of the most stressful and emotional experiences in someone’s life. Not only are you losing your partner and the dreams you shared, but also your sense of normalcy and routine. The future might suddenly seem very uncertain, and that includes uncertainty about the status of your health insurance. If you were on your spouse’s insurance plan, your children will still be covered, but you will not be once your divorce is finalized. Don’t worry, though, there are options available to you. Just make sure to look for a new plan within 60 days of losing your coverage.

COBRA

A temporary, but expensive, option for coverage after your divorce is applying for COBRA through your spouse’s employer. The COBRA law allows you to stay on your ex’s plan for up to 36 months after your divorce. The downside is that employers do not contribute to the cost of COBRA premiums, so you will have to pay the full amount. This might be quite expensive for you, but it could be a useful stopgap until you find a private insurance or Marketplace plan.

Employer Coverage

If you are working and your company offers health insurance, contact your HR department to find out if you can get on your employer’s insurance plan. Because you lost coverage due to your divorce, you can enroll into a new plan without having to wait until the open enrollment period. Companies with 50 or more full-time employees may be required to provide health coverage to all full-time employees, so if you work for a large company, consider looking into their plan.

Individual Insurance

illustration of caucasian woman with blue shirt and head gear sitting in front of a white computer. — *Working with an agent gives you the ability to ask about any discounts or lower rate options available in your area that you might not be able to access on your own.*

You can purchase your own individual health insurance plan for you or your family. You can purchase these plans over the phone or online with an EZ.Insure agent. Getting your own insurance plan will cost less than going with your ex’s COBRA plan, and it might offer more coverage. An EZ agent can sit down and go through all of the options with you, and compare them to the price and coverage you would receive through COBRA. Working with an agent also gives you the ability to ask about any discounts or lower rate options available in your area that you might not be able to access on your own. There are a variety of plans available, so there is no doubt EZ will be able to find you a plan that meets your needs and budget.

Marketplace Insurance Plan

Normally, if you want to enroll in an ACA Marketplace plan, you have to wait until the Open Enrollment Period from November 1 – December 15. But getting divorced qualifies you for a Special Enrollment Period, which means you have 60 days after losing coverage to sign up for a new plan. If you fail to sign up for a new plan within 60 days, you will have to wait until the regular Open Enrollment Period to sign up. You can shop your state’s exchange for an ACA-approved “metal tier” plan, and possibly find a discounted rate based on your income and location. If you are considered low-income, then you might qualify for some subsidies to help you save money.

Divorce is a devastating thing to go through, and losing your health insurance will only make things more stressful. EZ.Insure can make the process of getting covered less daunting, so that you have one less thing to worry about. Our agents are highly trained and can search for and compare insurance quotes within minutes at no cost to you. Our services are always free and there is never any obligation. Allow us to help you manage your health insurance needs during this difficult time – we promise to find you the best plan for your needs. To get free quotes online, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

4 EZ Tips For First Time Health Plan Shoppers

The world of health insurance can be intimidating. There are so many industry terms, as well as different types of plans with different coverage options and prices. Doing all of the necessary research to find the plan that fits your needs can feel overwhelming. You can opt for a short-term insurance plan that offers the basics and are fairly cheap, or a more comprehensible insurance plan. On top of trying to figure out which type of plan suits you, there are ways to save money on insurance that you could miss out on if you don’t know where to look. Here at EZ, we understand how intimidating it can all be, which is why we have some tips for making the process a little less unnerving.

1. Know The Terminology

The first thing you should do when jumping into the world of health insurance is familiarize yourself with the terminology. All of these terms can seem confusing, but they don’t have to be. Here’s a breakdown of some of the most important ones to know:

Premium– the fixed monthly rate that you pay the insurance company to cover you and your family. Premiums do not count towards meeting your deductible.
Deductible– a fixed amount you must pay before the insurance company either reimburses you or covers medical expenses. For example, if your deductible is $1,500, and you go to the doctor and get a procedure $3500 done, then you must pay $1500 first. Then, your company should take care of the last $2000, minus the amount of coinsurance you owe.
Coinsurance– Once your deductible is met, any insurance-covered procedure, treatment or service will result in a medical expense. The most common division of coinsurance is 80/20- health insurance companies pay 80%, you pay the remaining 20%. For example, in the above-mentioned scenario, you would have to pay 20% of it $2,000.
Copayment– a set amount you pay whenever you use a specific type of healthcare service. You can have a copay for primary doctor visits, specialist doctor visits, ER visits, as well as pharmaceutical copays on prescription drugs.

2. Know Your Budget

Before you start choosing specific insurance plans, weigh how much you are willing and able to pay for health insurance against your healthcare needs. Are you relatively healthy and just need the basics, or do you have a chronic condition and need more comprehensive coverage? These factors will play a big part in how much your monthly premiums will be versus how much your deductible will be.

If you are healthy, then a high-deductible health plan might be your best option. These plans offer low premiums and a high deductible- the thinking behind choosing a plan like this is that, since you are healthy, you will hopefully never have to pay your full deductible. It sounds like a bit of a gamble, but it can be worth it to save money on premiums.

If you need more coverage, then an ACA plan, or private plan that is offered by brokers or agents will work best because these plans offer more comprehensive coverage. There are different types of plans such as HMO plans with limited network coverage, and PPO plans that offer more in-network coverage (which costs more).

3. Know How To Save Money

After you’ve explored the different plan options available to you, don’t forget to look into the money saving options that come with some of these plans! You can save some extra money with:

- Subsidies– If you make between 100%-400% of the poverty line, then you are eligible for subsidies when purchasing plans on the ACA Marketplace. There are different kinds of subsidies:
  - Cost-sharing reductions- Cost-sharing reductions are discounts that lower your deductibles, copayments, and coinsurance. Your eligibility for these extra savings is determined by your household income.
  - Advance Premium Tax Credit– This is a tax credit that you can use to lower your monthly premiums. When applying for Marketplace health insurance, you estimate your expected income for the year. If you qualify, you will receive an advance tax credit that you can apply to the cost of your monthly premiums.
Health Savings Accounts (HSAs)- If you do go the route of getting a high deductible health plan (HDHP), then an HSA will help you save money. These accounts allow you to save up money to use for qualified medical expenses.You can contribute money to this account tax-free and allow it to roll over every year, but you can only have one of these plans alongside a qualified HDHP.

4. Get A Good Agent

If you are in the market for a health insurance plan, eliminate the hassle of doing all the research yourself and contact an agent. EZ.Insure offers highly trained agents in your area who can answer questions about all of these topics, and more. With us, you’ll speak with an actual human being, not an automated phone system. We will provide you with your own personal agent who will search and compare all available plans in your area, for free. Get the answers you are looking for quickly and at no cost. No pressure, no gimmicks. To get instant quotes, enter your zip code in the bar above. Or if you would like to get specific answers, speak to an agent by calling 888-350-1890.

Tag: health insurance help