Health Insurance and Obamacare Basics: What Are Your Options?

Since the Affordable Care Act now requires most every person to have insurance coverage in some form or fashion, what are our options?

I will assume that you are an individual or family who works for a small business with fewer than 50 full time employees.

If that describes you, then you are required to have some kind of health coverage or pay a tax penalty.



What Are Your Options?

Buying the coverage

You can either buy insurance at the Marketplace or you can buy health insurance the old-fashioned way through your local insurance agent or through another similar resource.

On the Marketplace: With this option, you’ll apply online through the main website – the one that had all the bad press for a bit. It’s relatively simple to navigate and will offer you a few options for most budgets. You can also find out if you will qualify for a tax credit.

Off the Marketplace: You can call an insurance broker to assist you or simply Google ‘Health Insurance [State]’ to find resources for whichever state you live in. You should have more options here, but you’ll be foregoing the potential tax credit.  Costs might be higher. Benefits might or might not be better.

You can engage both resources and then compare.  While you might have a difficult time finding a plan that is both affordable and jam-packed with features and low deductibles, you should be able to find something serviceable for your personal needs.

When is open enrollment (because you can’t apply anytime you want)

There has been a small misunderstanding about when you can apply for coverage on

At present, you can apply through March 31, 2014 (subject to change, of course).

After this initial period, the Exchange will allow for open enrollment periods that are synced with Medicare’s open enrollment: October 15 – December 7.

You will not be able to wait until you have a health event and then go buy coverage if it’s not during the open enrollment. However, there will be other opportunities.

These other opportunities to enroll are called ‘qualifying life events‘ wherein you can purchase coverage. The following is from Karen Pierce, my agency’s resident health insurance human encyclopedia:

Qualifying Events:
  • A change in income
  • A change in your status such as marriage, death of a spouse, divorce, legal separation or annulment
  • A change in your number of dependents including birth, death, adoption
  • A change in your employment status or the employment status of your spouse or dependent
  • A dependent becoming ineligible for existing coverage due to attainment of age
  • You will have 60 days from the date of your qualifying event to secure new coverage without paying a penalty.

What to do now?

If you are new to purchasing your own coverage, I’ll share from my experience. As I’ve mentioned, my expertise is property and liability insurance. While I observe my life and health licensed colleagues help clients, I do not directly work in this arena.

Below was my personal process:

1. Go ahead online and walk through the application process. When I went through the process, I had prices super cheap and super low in benefits. Then I had some that were mostly comparable with what you can find off of the exchange with a price tag to match.

2. Call an Insurance Agent: I have the good fortune of working in an agency, so I just sat down with the health insurance experts to go through my options. In my case, I had a current policy that I was able to renew.

3.  Compare .GOV vs. other options:  I reviewed my options from the Exchange and what I was able to get through the regular insurance marketplace. It was helpful to have an agent a few doors down to help me evaluate the pros and cons. Hopefully, your agent is willing to help you navigate the process.

4.  Take out your budget and make a decision: I was able to hold on to my current individual plan. It fit my budget and will hold me over while the new program gets more wrinkles ironed out. Review your budget and make the wisest decision for you.

Hopefully this information will give you a framework by which to take on the process.

Drop any questions in the comments. I’ll have my professional health insurance agent colleagues weigh in on the answers.

Disclaimer: I am a licensed Property and Casualty Insurance Agent. This post is for informational purposes only and should not be considered direct advice. Each reader has her or his own circumstances and should consult with a Licensed Life and Health Insurance professional on those details to help make the most informed decision possible. 


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