Do you live in New Jersey and need to know what it takes to purchase individual & family health insurance policies? Here are 10 frequently asked questions—and answers—courtesy of NorthEast Insurance Services.
If I use an agent or broker, will the premium on my plan go up?
No. Your premium will not increase with an agent. Rates are set by the state based on criteria like your age and location.
How much does it cost to pay an agent or broker for helping me with the process?
You do not have to pay anything: agent/broker commissions along with other administrative costs for the insurance carrier are part of the rates filed with the state, and their services are compensated by insurance companies.
What's the open enrollment schedule, and when will my coverage begin?
You may enroll from November 1st, 2015 to January 31st, 2016.
If you sign up between November 1st, 2015 and December 15th, 2015, coverage begins on January 1st, 2016.
If you enroll from December 16th, 2015 to January 15th, 2016, and coverage starts February 1st, 2016.
The final enrollment period is January 16th, 2016 to January 31st, 2016, and it has a March 1st, 2016 start date.
What if I cannot enroll by January 31st, 2016?
Unfortunately, you won't be able to apply until the next open enrollment period beginning January 1st, 2017. But, if you have a qualifying life event, the rules of enrollment change.
How do I know if I've had a qualifying life event?
Life events that may qualify you for a Special Enrollment Period include:
- Getting married
- A birth in the family
- An adoption or placing a child for foster care or adoption.
- Loss of other health care coverage
- Getting a new permanent residence or moving to the U.S. from another country
- Obtaining U.S. citizenship or residency
- Being released from incarceration
Does losing job-based coverage entitle me to a Special Enrollment Period?
Yes. Should you lose your job-based coverage, you're able to apply for a Special Enrollment Period. Potential qualifying coverage losses include:
- Coverage cancellation by employer
- Resignation or voluntarily leaving your job
- Down-sizing, lay offs, or termination
- A job-based plan does not meet the affordable or minimum value criteria, making you eligible for a premium tax credit
- Losing coverage through a divorce
- End of COBRA coverage
- Losing coverage under a parent's plan by turning 26 years old
- Medicaid or the Children’s Health Insurance Program (CHIP) expiration
Important: voluntarily dropping job-based coverage or COBRA before the plan year ends will disqualify you from the Special Enrollment Period. Failure to pay premiums on existing coverage will also cause disqualification.
If you don’t renew a job-based plan when its plan-year ends, you will qualify for a Special Enrollment Period to buy a Marketplace plan.
Very important: Failure to renew a job-based plan that meets affordable and minimum value criteria will disqualify you from a premium tax credit. To see if your plan falls within these criteria, have an employer's representative fill out the Employer Coverage tool (PDF). (This information was provided by healthcare.gov)
How many days after losing coverage do I have to re-enroll?
You must enroll within 60 days after losing coverage or a qualifying life event. After 60 days, you will no longer be eligible for the Special Enrollment Period and must wait for the next open enrollment.
What do I do if it says my children are eligible for Medicaid on the marketplace?
You may contact your home state's Medicaid office to provide answers on Medicaid eligibility.
If I have some existing conditions, can I be denied coverage or will my rates be higher than my last plan?
Under the Affordable Care Act, it is illegal for insurance providers to deny coverage for pre-existing medical conditions, and your rates will not increase.
What are the premium costs for families with many young children?
Large families are not penalized with additional premiums. The Affordable Care Act ensures that premiums are capped for group health insurance policies. At the most, you will have to pay a premium for three children per household, plus the number of adults who belong to your household (including yourself). Four or more children do not necessitate additional premiums. Once those children reach 21 years of age, premiums will apply.
If my doctor leaves my network and doesn't accept my new plan, can I switch plans to stay with him or her?
Without a qualifying life event, you must remain in your enrolled plan until its plan-year expires, and it's time for renewal.
Serving New Jersey, NorthEast Insurance Services' agents are ready to answer these hard questions and more to help your family get the health insurance coverage they need. If you're interested in more information from NorthEast Insurance Services, please call (732) 972-1771 x100. You can also visit them online to learn more about group health insurance and business insurance.