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Special Enrollment Period: Discover Healthcare Options after Open Enrollment

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Open Enrollment is your window of opportunity to sign up for a Marketplace health insurance plan. It usually occurs between November 1 and January 15 but varies by state. If you miss your chance to enroll or change your plan during open enrollment, you might not be able to sign up for a health insurance plan until the next open enrollment period. However, special enrollment periods might offer you a chance to enroll despite missing the deadline.

There are a series of specific circumstances outlined below that qualify for special enrollment.  A Special Enrollment Period enables you to sign up for coverage outside Open Enrollment. We’ve put together this article to provide clarity on what circumstances qualify for Special Enrollment Period. Here’s what you need to know. 

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days. (If you lost TennCare or CoverKids coverage in the past 90 days, you may qualify for a Special Enrollment Period.)

Life Changes

Significant life changes may qualify you for a Special Enrollment Period. Below you will find a list of qualifying life changes.

Household Changes

You may qualify if you or anyone in your household has undergone any of these changes in the past 60 days.

  • Gotten married – In this case, coverage will start on the first day of the month after you pick a plan
  • Adopted a child, had a baby, or placed a child in foster care – Coverage starts the day of the event
  • Lost insurance coverage due to a divorce or separation
  • Lost coverage due to a family member’s death

Moving Residences

Unless you’re moving from outside the country, you must prove that you had health coverage for at least one of the 60 days before your move. 

  • Changing residences to a home in a different ZIP code or county
  • Moving into the US from a US territory or foreign country
  • Moving to an area to attend school
  • Changing location for seasonal work
  • Moving to transitional living or a shelter

Loss of Coverage

Job-based Coverage

  • You lose employer-provided health coverage through your job or a family member’s job
  • Your parent or guardian is no longer able to provide coverage because you are no longer considered dependent.

Individual Health Coverage

You may qualify if you cannot maintain individual coverage for the following reasons.

  • Your plan is discontinued
  • You move out of the plan’s service area
  • Your household income has decreased, and now you qualify for savings on a Marketplace plan. 
  • Your coverage ends in the middle of the calendar year.

Denied Medicaid or Children’s Health Insurance Program (CHIP) Coverage

  • Household income has changed
  • Your child aged out of TennCare or CoverKids program 
  • Your state agency didn’t notify you that you weren’t eligible until after the Open Enrollment period ended.

Other Qualifying Circumstances for Special Enrollment

Many unusual circumstances may qualify you for Special Enrollment. Here are just a few of them.

  • Being impacted by a natural disaster
  • Becoming a US citizen
  • Leaving incarceration
  • Gaining membership in a federally recognized tribe
  • Gaining status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Starting or ending service as a member of VISTA, AmeriCorps State and National, or National Civilian Community Corps (NCCC) 

Discover Your Health Insurance Options 

Signing up for health coverage during Open Enrollment is ideal, but life doesn’t always work that way. If you have special circumstances that qualify you for Special Enrollment or need additional guidance, please contact us today! At Get Covered Tennessee, we are here to help you make healthy choices for you and your family.

 

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Understanding Health Insurance: Premiums, Deductibles, & Copays

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Health insurance can be complicated. As everyone knows, it is important to be insured, but the process and terms used by insurance companies can leave many feeling confused or overwhelmed, contributing to costly mistakes. 

Understanding the terms used when considering an insurance policy is essential. We’ve put together this helpful guide to help you navigate the complexities so you can choose a policy feeling confident that it’s the best one for your unique needs.

UNDERSTANDING COMMON TERMS USED IN HEALTH INSURANCE

What is a Deductible?

“Deductible” is a term we’ve all heard, but do we really know what it means? The deductible is the amount you will pay out of pocket for covered expenses before your insurance plan starts to pay. 

With a $1000 deductible, for example, you’ll pay the first $1000 of your yearly bills before the insurance plan begins to cover all or a portion of the costs. 

Deductibles can vary significantly from plan to plan. A higher deductible will usually coincide with lower monthly premiums. 

What is a Premium?

An insurance premium is the amount due monthly for continued coverage. Certain factors, including age, location, health, and lifestyle, can affect the premium amount in some insurance plans. 

What is a Copay?

Copayments, or copays, are paid in addition to a deductible. They do not contribute to your deductible and are considered a separate out-of-pocket expense. 

Copays are a fixed fee for a specific service, such as a doctor’s appointment, an appointment with a specialist, or a visit to the emergency department. 

Copay amounts vary depending on the care being provided and the insurance plan. 

HIGH DEDUCTIBLE HEALTH PLAN VS. LOW DEDUCTIBLE HEALTH PLAN

HIGH DEDUCTIBLE HEALTH PLAN

During enrollment, one of the first things you may wonder about is whether you should choose a high-deductible or a low-deductible plan. 

There is no right or wrong answer, and the decision is ultimately based on your individual needs. Compared to a traditional health insurance plan, a high-deductible health plan comes with a higher deductible and lower premium. You pay less each month, but you’re responsible for a greater portion of out-of-pocket health care costs when and if they occur. 

High-deductible plans also typically have higher out-of-pocket maximum limits, but once you reach that limit each year (including what you pay for your deductible, copayments, and coinsurance), the insurance pays 100% of the allowable amount for the rest of the calendar year.

The other advantage of high-deductible insurance plans is that they usually offer a health savings account (HSA) to assist with costs. This tax-advantaged account can be used for medical expenses, including eye exams, weight loss programs, dental expenses, nursing homes, and long-term care. 

LOW DEDUCTIBLE HEALTH PLAN

Low-deductible health insurance plans carry a smaller deductible compared to a high-deductible health plan. That means that when you get sick, you pay less money upfront before your plan kicks in. The trade-off with a low-deductible plan is that you pay a higher monthly premium.

An obvious downside to a low deductible plan is that if you don’t end up needing more extensive medical care, you’ll have paid a higher monthly premium for nothing. The silver lining, however, is that low-deductible plans make managing and predicting health care expenses easier if you develop a serious illness, are injured, or need surgery. There’s no large out-of-pocket expense to worry about since the deductible is lower.

HOW TO CHOOSE THE RIGHT HEALTH INSURANCE PLAN

With all of these factors, what is the best way to choose the right health insurance plan for you? 

First, you need to compare the different types of plans, keeping in mind the most common types of health insurance policies are HMOs, PPOs, EPOs, and POS plans. Determine which you need after considering the out-of-pocket costs you will pay, monthly premiums, and which doctors you can see based on your personal and family needs. 

After this, you will need to carefully read the summary of benefits to fully understand all costs and coverages. 

Make sure you understand referrals, health savings accounts, and networks. 

Finally, check the scope of coverage and ask about medication coverage and other covered services to make sure all your medical needs are covered. 

FOR MORE INFORMATION, CONTACT FAMILY & CHILDREN’S SERVICE TODAY

We know that insurance can be complex. Understand health insurance with GetCovered Tenn. Learn how premiums, deductibles, and copays work to make informed decisions about coverage options. Contact us today for more information. 

 

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Health Insurance for Young Adults: Navigating the Transition from Parental Coverage

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As young adults begin stepping into a world of independence, one of the most crucial aspects they must navigate is their health insurance. Often, this transition from being covered under a parent’s plan to securing your own coverage can be daunting. Understanding your options and knowing where to turn for guidance is essential for maintaining essential healthcare coverage during this pivotal life stage.

The Importance of Health Insurance for Young Adults

Many young adults underestimate the importance of health insurance, thinking it’s an unnecessary expense or something they can delay until later. However, having health insurance is crucial for safeguarding your well-being. It helps cover routine check-ups, preventative care, and unexpected medical costs, saving you from financial strain and potential health issues in the long run.

Challenges Faced by Young Adults

Transitioning from parental coverage comes with its own set of challenges. Common issues include:

  • Job Changes and Employment Status: Young adults often face job changes, internships, or gig work that might not offer health benefits. This can make securing consistent health insurance more complex.
  • Aging Out of Parental Coverage: Many young adults lose access to their parent’s health insurance plan upon turning 26. This is a crucial age where planning ahead can prevent a gap in coverage.
  • Financial Constraints: Managing student loans, rent, and other expenses can make it challenging to prioritize health insurance. Understanding affordable options is key.

Options for Obtaining Health Insurance

When it comes to securing health insurance, young adults in Tennessee have several options:

Employer-Sponsored Insurance

Many full-time jobs offer health insurance benefits. Check if your job provides a plan and understand the coverage details. Even part-time jobs sometimes offer insurance, so it’s worth asking.

ACA Marketplaces

The Affordable Care Act (ACA) provides access to health insurance through state and federal marketplaces. In Tennessee, you can explore options through the HealthCare.gov website. ACA insurance plans offer various levels of coverage and financial assistance based on income, which can make health insurance more affordable.

GetCovered Tennessee Navigators can help individuals navigate through the application process, provide detailed information about insurance plan, and answer any question individuals have in regards to the plans that are available through Marketplace.

Staying on a Parent’s Plan

Under the ACA, young adults can stay on their parent’s health insurance plan until age 26. If you’re still eligible, this option can be cost-effective while transitioning to independence.

TennCare and CoverKids

TennCare (Tennessee’s Medicaid program) and CoverKids (Tennessee’s Children’s Health Insurance Program) offer health insurance options for low income children, pregnant women, parents and caretaker relatives and low income aged, blind, or disabled individuals While CoverKids primarily serves children under the age of 19 and pregnant women.

Our certified Navigators will be able to help with TennCare and CoverKids application and answer any question related to eligibility.

Considering Coverage Needs and Affordability

When selecting a health insurance plan, consider the following:

  • Coverage Needs: Assess what type of coverage you need, such as emergency care, preventive services, or specialist visits. Choose a plan that aligns with your health needs.
  • Affordability: Consider premiums, deductibles, and out-of-pocket costs. Balancing your budget with the coverage you need is essential for finding the right plan.
  • Provider Networks: Ensure the plan includes your preferred doctors and hospitals to avoid higher costs.

Step into the Future with Confidence and Coverage

Navigating health insurance might seem overwhelming, but with the right information and resources, you can make an informed decision, ensuring you have the coverage you need. Health insurance is an investment in your future well-being, so contact us to explore your options in Tennessee with GetCoveredTenn for personalized assistance. Offering specialized knowledge and advice, GetCoveredTenn can guide you through the process and help you find the best coverage for your needs. By taking these steps, you’re not just securing health insurance—you’re stepping confidently into a future where your health and financial stability are protected. Prioritize your health and learn more about your health insurance options today!

 

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