Health Insurance Information

Individual & Family Health Insurance Plans — this is your choice if you do not have employer-provided insurance, if you are planning on full or semi-retirement before you become eligible for Medicare (age 65 for most people) or if you otherwise need to buy your own health insurance.

Health Insurance Plans are issued by private health insurance companies or carriers. They are often categorized into Comprehensive and Short-Term Plans.

The major distinctions between the two:

• Comprehensive plans provide more benefits and better long-term coverage. These plans cover pre-existing conditions and a set of minimum essential benefits required by the Affordable Care Act, including items such as preventive care, mental health, pregnancy and childbirth, etc. However, you can generally only buy these plans at certain times of year (open enrollment is typically Nov 1–Dec 15) or when you have certain qualifying life events (change in family status, loss of other coverage, etc.) Comprehensive plans usually have a higher monthly premium than short-term plans, but government subsidies may make comprehensive plans less expensive for qualifying applicants.
• Short-term plans are designed to give you temporary, limited insurance coverage for unexpected medical emergencies when you don't have a comprehensive plan. For example, short-term plans may be a fit if you are between jobs or waiting for a comprehensive plan to begin. Short-term plans typically do not cover pre-existing conditions or many benefits required by the Affordable Care Act, such as preventive care, mental health, pregnancy and childbirth, etc. Coverage length varies by state and insurance company, and can be anywhere between 1 to 36 months (including renewals.) Some states do not have short term plans at all. These plans are not eligible for government subsidies, do not meet the requirements of the Affordable Care Act, and can deny applicants based on medical history.

Some people refer to short-term plans as "just-in-case" plans because they typically provide coverage, up to a pre-set limits, for accidents or unforeseen illnesses for people that do not have a comprehensive health insurance plan. Short-term plans are not usually meant as a long-term replacement for comprehensive plans because short-term plans generally do not cover items that many people need in the long-term, such as preventive care or coverage for pre-existing conditions.

States that currently significantly limit or do not allow short-term plans include California, Colorado, Connecticut, Hawaii, Massachusetts, New Jersey, New York, Rhode Island, Vermont and Washington (as of April 2019.) As an additional incentive for people to maintain comprehensive health insurance, some states may assess a tax penalty for people who do not maintain qualifying health insurance. Short-term plans do not count as qualifying health insurance. This tax penalty may affect residents of Massachusetts, New Jersey, and the District of Columbia in 2019, and Vermont in 2020. Additional states are considering adopting this tax penalty because the federal government stopped enforcing this penalty in 2019.

Everyone in the United States should carry health insurance given the cost of healthcare in this country. There are a number of health insurance plans and options out there ranging from limited, short-term coverage, to more comprehensive coverage across a broad range of products and services. The best plan and value for you will depend on your needs and budget.

Health Insurance Questions and Answers

If I'm already enrolled in a health insurance plan, does it still make sense for me to compare and consider alternatives during the annual Open Enrollment Period (OEP)?

The short answer is yes—plans change and your coverage needs are likely to change over time. We recommend that you review your coverage needs during OEP, connect with a licensed insurance agent and see if there are opportunities for you to save on your overall health costs. Things that could change include:

• Monthly premium costs
• Network coverage (physician network, what's "in-network" and what is not)
• Co-pay amounts, deductibles and other cost-sharing
• Coverage for prescription drugs and other benefits

In addition, if you have a short-term plan, OEP is the best time to consider upgrading to a comprehensive health insurance plan. Outside of OEP, only people with qualifying life events can buy comprehensive health insurance plans.

When can I enroll in a comprehensive health insurance plan?

Comprehensive health insurance plans are typically available for purchase during the Open Enrollment Period (OEP). There is a set time every year when anyone can apply for a comprehensive health insurance plan. At other times of the year, you need to have a qualifying life event (such as a change in family status or loss of other coverage) to buy these plans. The Open Enrollment Period generally runs from November 1^st through December 15^th each year, but the exact dates may vary by state or year. When you sign up for a plan during OEP, coverage will typically start January 1^st  of the next calendar year.

Special Enrollment Period (SEP)

You may be eligible for Special Enrollment Period (SEP), meaning you can buy a comprehensive health insurance plan outside OEP. Generally, you have 60 days to apply if you have a qualifying life event such as:

• You recently or are about to lose your employer sponsored coverage
• You exhausted the time of your COBRA coverage
• You recently or are about to move to another state
• You got married or entered into a domestic partnership
• You added a child to your family (by birth or adoption)
• You are no longer eligible for student health coverage
• You are you turning 26 and no longer eligible for a parent's plan