The best tips to obtaining Health Insurance during Special Enrollment


The rules are different for Maryland, D.C. and Virginia. Please consult a broker!

Open Enrollment this year is from November 1st 2015 through January 31st, 2016. For all other times besides Open Enrollment, it is call Special Enrollment. You have to meet one of the qualifying conditions to be able to enroll. Each situation is different and we are here to help. Please speak to a broker to determine if your plan needs to be on or off exchange. Some of the qualifying conditions that need to be met are things like:

  • Getting Married or Divorced

  • Having a child, adopting a child, or placing a child for adoption or in foster care

  • Certain changes in income

  • Moving from Maryland or moving from your home state to another state.

  • Having a change in disability status

  • Gaining or losing a dependent

  • Becoming Pregnant ( Maryland on exchange only) Not off exchange

  • Certain losses in health coverage which include loss of employer sponsored coverage, but not termination from job or consumers failure to pay for existing plan

  • Becoming Ineligible for Medicaid or MCHP

  • Turning 26 years old if you are enrolled in coverage through your family’s plan

  • COBRA Coverage period ends

  • Other changes that may affect eligibility include

  • change in tax filing status

  • change of citizenship or immigration status

  • incarceration or release from incarceration

  • change in status as an American Indian/Alaska Native or tribal status

  • Certain errors or exceptional circumstances. These are reviewed on a case-by-case basis.

Health Insurance is paramount to any individual, family or business to maintain health and wellness as we age throughout our lives. There are many factors that go into a health insurance plan and there are a wide range of options to choose from. Most consumers do not understand their insurance and we want to make sure that you not only understand but utilize it to it’s maximum benefit to get the most for your hard earned premium dollars.

Comrade Financial Group consists of a primary broker with other associate brokers helping you navigate the wide range of options that best fit your circumstances. We all live in a diverse, densely populated area and finding the right providers, carriers and plan can sometimes be a challenge. We want to make the process for you simple, understandable, comprehensive and the right plan for your needs.

There are some key words and factors that determine the benefit level and out of pocket liability you assume when purchasing a health insurance plan and we will go over some of those below:

  • Premium: When most people chose a health insurance plan, they choose by premium and not benefit level or even liability level. This is the number one mistake we find over and over again. First determine the benefit level and then match the premium with the highest and best benefit level that is affordable. Second you need to determine your maximum liability you want to assume during the duration of the plan. Most plans are yearly and your deductible and out of pocket max reset each year.

  • CoInsurance: We feel that the Co Insurance you assume is the most important factor that is part of any health insurance plan. Many do not realize that co insurance is the liability level you assume which is your share of any service or treatment you select to obtain. If your deductible is $1000 and your co insurance is 20% and a treatment selected costs $10,000 you know you have to pay your deductible. Many however do not fully understand they are still liable for 20% of the remaining $9000 charge. We strive to educate our clients and help them obtain plans with 0% co insurance so at least they know what their liability is over and above their deductible, which is zero.

  • Deductible: Many plans issued today are very tricky and it can cost you dearly if you do not have a clear understanding of when your deductible applies and when it does not. Bronze level plans require you to meet your deductible first before benefits become available, however as you move up the scale to Silver, Gold, and Platinum plans your deductible is lower and not applicable for most services. If you are healthy and not in need of a surgery or much treatment, it would be safe to say that having a high deductible is the primary choice for many. For others that are in the baby making years or older clients that need surgeries, many opt for lower and even no deductible plans.

  • Optimal Plan Choices: HMO plans are optimal for consumers that do not travel much and seek treatment for in network providers as any out of network treatment would not be covered under the plan. PPO plans allow in and out of network provider services but out of network usually cost more to the consumer. POS plans allow both access to HMO and PPO provider networks and provide the most services for free such as free Dr. office visits, free generic prescriptions, free lab work and many other services which would normally be a charge with other plans.

Each plan choice is yours to make and it just takes a little time speaking to a broker to understand your options and the plan choice. Do not make a hasty decision based on premium alone. The plan does have to fit your budget and with the advent of the PPACA law many have saved money on their plans with advanced premium tax credits as well as cost sharing reductions. For a free quote and consultation, please contact us so we can explore all of your options.

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