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Individual Health Insurance Application - FAQ

Q: When Does Open Enrollment begin and end this year?

Open Enrollment begins each year on November 1st and ends on December 1st. This means you have 45 days to shop this year, not 3 month. Outside this timeline, you cannot change or purchase a plan UNLESS you have a Qualifying Event. Examples would be losing Employer Group coverage, turning age 26 and losing coverage through your parent's plan. Having a Qualifying Event allows the individual a SEP - Special Enrollment Period.

Q: If I shop during this time, when will my new policy go into effect?

January 1st, If you apply during the annual Open Enrollment period of Nov 1st - Dec 15th, the new policy will always be effective January 1st of the following year.

Q: What if I don’t apply for a policy during Open Enrollment?

The only people that can buy outside this time frame MUST have a Qualifying Event in the prior 60 days of their application, and must provide PROOF of that qualifying event. (An example of Proof would be a COBRA letter showing you lost Employer group coverage in the last 60 days.)

Q: What are some Qualifying Events to gain, drop or change coverage?

Examples of a Qualifying Event include losing group coverage, turning age 26 and losing coverage through your parent's plan, getting married, having a baby, moving to another state and out of the 'servicing area' of your current plan, etc.

Not paying your premium on time and lapsing your policy is NOT a qualifying event!

Q: If I can’t do this on my own and need assistance, what are my options?

If you get stuck and need help, you can contact CB Health Insurance! We are here to help you and walk you through your options and help you find the BEST plan that meets your needs and budget! Even if you have to pay us a consulting fee, it will provide you with peace of mind that you have looked at all options and found the one that will best meet your needs without calling every insurance carrier and doing all the research on your own. (Of course you can call the marketplace or an insurance carrier direct; however, neither may able to help explain plans and assist in picking the BEST plan that suits YOUR needs!

Q: Can I shop on my own for coverage?

Absolutely! Go to our health quotes page here: Health Insurance and click the link to apply for either ON or OFF exchange plans. Feel free to check both. NOTE: Some carriers have plans only on or only off the exchange. Carriers like Blue Cross and Blue Shield of IL have plans both on and off the exchange.

Q: What is the difference in price ON and OFF the EXCHANGE?

There is no difference. The price is identical. However, IF you qualify for a TAX CREDIT based on your income, the government is actually paying a portion of your medical premium for you, thus lowering your overall premium. NOTE: If you do not qualify for a tax credit, there is no need to go to the government exchange (healthcare.gov) to apply.

Q: Can I qualify for a Tax Credit?

If your income is less than 400% of the Federal Poverty Level (FPL), you may qualify for a Tax Credit. (See document here) Depending on how many people are in your household and the total Adjusted Gross income for the household, you could receive a tax credit. If you are married, you must as “married filing jointly” to receive a tax credit. NOTE: Income below the Medicaid limit (In IL this is 138% of the FPL qualifies you for the state Medicaid program.

Q: If I am buying a plan during a SEP, when does coverage begin?

The coverage will begin the 1st of the month AFTER you submit your application; whether you submit an application the 1st or the 31st of the month, the effective date will the be the first of the month following the date the application was received by the marketplace or insurance carrier. NOTE: Policies cannot be BACK-DATED, so people that are deciding between COBRA or enrolling in an individual policy could have a lapse of coverage. To avoid this, the individual can purchase a short term policy in the interim.

Q: Once I’ve secured coverage, is it effective tomorrow?

No. The new ACA (Affordable Care Act) plans are ONLY effective on the first of the month. Whether you purchase this on or off the exchange does not matter. Non-ACA plans, such as a Short Term Medical plans, can have a 'middle-of-the-month' effective date and typically become effect the DAY AFTER the application date.

Q: What do I do to prevent a short gap of coverage?

If you need coverage for a month or two before the new plan kicks in, purchase one-month Short Term Medical. NOTE: Short term policies are not ACA approved; however beginning with tax year 2019, there is no longer a tax penalty for individuals who are uninsured or do not have an ACA qualified plan. Federal law allows individuals to buy up to 365 days of coverage; State of IL laws limit this coverage to 6 months or 180 days MAX.

Check for rates and plans here: Short Term Medical.

Q: When do I typically owe my first premium?

You’ll need to pay the first premium within a 30-day grace period of the policy effective date or you will not have insurance.

Q: If I’m eligible for a Tax Credit (subsidy), what portion of my premium do I pay each month?

You don’t need to pay the full premium. You will need apply for the Tax Credit through the government website; most companies have links from their website to go to the 'marketplace' and get this tax credit. If you qualify, you can receive the Tax Credit one of two ways:

  1. Apply towards your premium so that you pay the reduced amount. The total premium for your coverage is $350/month, and you receive a tax credit of $50/month, you only need to pay $300/month to the insurance company; or
  2. You can pay the whole amount and use the tax credit when you file your tax return.

Most people take option 1.

Q: Do I have to pay for a Pediatric Dental Plan?

It depends. You’ll either need to select a pediatric dental plan for children under age 19 or verify that you have the coverage elsewhere. The ACA states that one of the mandatory Essential Health Benefits that must be covered now is for pediatric dental. However, many insurance carriers chose not to embed this coverage in the medical plan, requiring you to purchase a separate dental policy to cover this. Remember, ACA requires this to be offered to you. There is no penalty for not having this coverage. (NOTE: If you are being billed for this by the insurance carrier and DO NOT want it, you can call and get this removed! Some carriers have been adding this AUTOMATICALLY for any children regardless of age; we have seen people being billed $40 per child even if it is a newborn that has no teeth! Be sure to check your bill or have CB Health Assist you.)