What is it?
Since 2014, the ACA changed the rules of when you can buy your individual health insurance plan. There are two times during the year you can buy your own health plan:
- Annual Open Enrollment - Each year, from November 1st through January 31st, you can enroll in an individual health plan. Regardless of your health (i.e. if you haver pre-existing conditions, it does not matter), you can buy a plan;
- Special Enrollment Period (SEP) - You can enroll anytime during the year if you have a “Qualified Life Event,” you have 60 days from the time of your “Qualified Life Event” to enroll in a plan. “Qualified Life Events” include:
- You had a health insurance plan and you lost that plan. Common examples are loss of your prior employer group health plan or loss of your Medi-Cal coverage;
- Having a baby;
- Got married;
- Got divorced and are no longer eligible under your former spouse’s plan;
- Moved permanently into California;
- COBRA coverage is expiring;
- Just gained citizenship/lawful presence;
- Just returned from active duty military service.
When will your plan become effective?
What types of plans are available?
The Affordable Care Act (ACA) mandates all insurance companies sell the same 4 levels of plans. These plans are categorized in “Metal-Tiers.” Bronze, Silver, Gold and Platinum. All four levels must also cover the same types of services. Therefore, regardless of which insurance company you select, the plans are all the same. The differences will be price and where you receive your care (which doctors and hospitals you can use).
The more expensive the metal tier, the lower the deductible and copay, but the higher the price. For example, a Bronze plan has a high deductible, but a lower price than a Silver plan.
Terpstra Benefits represents all the available major insurance companies. Whether buy your plan direct or use Terpstra Benefits, your monthly premium is the same.
As a “Certified Insurance Agent” for Covered California, Terpstra Benefits can help you enroll in Covered California and guide you through the process of finding the plan that meets your needs.