Individual Medical Insurance Open Enrollment November 1 – December 15
It is the time of year when:
- If you are not enrolled into an Individual Medical Insurance Plan you can enroll and you cannot be declined.
- If you are enrolled in a plan you can change to a different plan.
As a broker, I can help with all of the available plan options. There are plans you can enroll into directly (Kaiser and Regence) and there are plans offered on Wahealthplanfinder.org (Kaiser, Regence, Premera, Ambetter, Molina, Community Health, Bridgespan, Life wise & others.
This year will be different than the last 5 years because of a significant change in the way premium credits/payment reductions will be calculated.
The issue is a change made during the pandemic that was scheduled to expire this year is not being extended. Typically, I would say “they said it would end”, but they extended the Tax cuts that were also scheduled to expire.
End of Expanded Health Insurance Tax Credits
What will end for many people is the tax credit which lowers their monthly payment. This will impact a lot of people. Prior to the pandemic, there was an income ceiling to be eligible to receive a credit. The ceiling is 400% of the Federal Poverty Level. This number varies with family size. During the pandemic, the ceiling was removed, and the credit was based on a percentage of your income. In 2025 a person earning more than 400% of FPL could receive a credit but in 2026 they will not. The people who will be most impacted are age 55+ since medical insurance rates increase with age.
Alternatives to ACA Qualified Medical Insurance
There are Non-Qualified Programs that are available all year long:
SPECIFIED BENEFIT LIMITED MEDICAL/INDEMNITY PLANS
ASSOCIATION-SPONSORED HEALTH PLANS
HEALTH CARE SHARING MINISTRY PLANS
These plans typically have coverage restrictions for Pre-Existing conditions and or coverage limits. These plans will pay for any new conditions that arise after the effective date but will not pay for Major Medical conditions that exist prior to effective date. However, they will pay for Office Visits, Lab Test, Xray, MRI’s and Annual Examinations.
Because these programs restrict pre-existing conditions rates can be less than a qualified plan, especially for people aged 50 + who have high incomes and do not qualify for a premium subsidy.
Are you a Small Business Owner or a 1099?
Did you know as a business, you can enroll into a Qualified Plan at any time during the year. You require a minimum of 1 W-2 employee or 2 employees. There are better plan options available to Businesses, plans with Lower Deductible’s, Out of Pocket Maximum’s & plans that offer access to more doctors.
With 30 years’ experience I understand the plans. As a broker I can help you to determine the plan choice that is best for you.
Why you want to work with a broker
- As an agent I have information about companies and plans options not available when calling the 800#.
- This is probably most important reason, if you have a problem, or dispute I am there to help you get it resolved. No one ever expects a problem. I am there to advocate for you.
- There is no additional cost for you to use a broker as we are paid by the insurance company. Using a broker does not change amount you pay.
To find me on wahealthplanfinder.org
