What is “Guaranteed Issue”?
“Guaranteed issue” means that regardless of your health history or current conditions, you are guaranteed to receive health insurance with no restrictions or waiting periods related to preexisting conditions. How can insurance companies afford to provide coverage to everyone? Young, healthy policyholders who funnel dollars into the system but file very few claims are the key to making it affordable for insurance providers to offer guaranteed issue policies across the board, turning no one away.
Paying for a Policy You Don’t Need?
So – if you are a healthy Texas resident under 30 years old with no anticipated healthcare needs, why would you spend your hard-earned paycheck to purchase a product with bells and whistles that far exceed what you need?
There are three reasons:
- Essential Health Benefits – provides important benefits such as mental health, contraception, as well as, preventative and wellness services. of open enrollment.
- Open Enrollment – a specified period to enroll in health insurance.
- Financial exposure – the amount of potential financial loss that can be incurred with a major injury or illness.
Essential Health Benefits
The Essential Health Benefits are a set of 10 categories of services health insurance plans must cover under the ACA. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and children, and mental health services. Essential health benefits, like birth control coverage, are minimum requirements for all Marketplace plans. Specific services covered in each category based on the plan selection.
Open Enrollment
“Open enrollment” is defined as a set period during which individuals review their coverage options and submit an application for health insurance. ACA Open Enrollment period running from November 1 to December 15.
Open enrollment is a mechanism to control for individuals waiting until they are sick and then securing health insurance. You can imagine that if individuals waited until they were sick to seek coverage, the health insurance market would have no healthy premium dollars to cover all the claims. The entire system would crumble.
So, if I am young and healthy, why should I take advantage of the Open Enrollment period?
When ACA Open Enrollment period closes on December 15th , you will be locked out of the insurance market until the next Open Enrollment period begins on November. In other words, as of December 16th, if you have chosen no plan, you cannot GET an ACA compliant plan a plan for the rest of the year, unless you qualify for a Special Enrollment Period (SEP).
To qualify for a SEP you must experience a certain life event, such as loss of coverage, due to marriage, moving, having a baby, divorce or turning 26. Depending on your SEP type, you may only have up to 60 days before or 60 days following the event to enroll in a plan.
Financial Exposure
Once open enrollment has closed, those individuals who did not secure coverage will be responsible for all healthcare expenses, including prescriptions, office visits, lab costs, x-rays and hospital expenses. No copays, no discounted rates – simply paying out of pocket for routine check-ups, illnesses, accidents, and more. Consider this:
- A broken ankle with surgery can range between $6,000 and $25,000
- A broken leg averages between $17,000 and $35,000
- Anterior cruciate ligament reconstruction averages between $20,000 and $50,000
- And it can continue to go up, depending on your accident…
You are young. You are active. You are healthy. But what if you catch a strange bug on that amazing summer trip you have planned, or break your wrist in a minor bike wreck? Do you want to pay completely out of pocket when the unexpected strikes?
STATESIDE CAN HELP!
Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.
Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs.
Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods.
Stateside can be contacted either by phone (866) 444-3332 (toll free) or by email at info@texasplans.com. Our Telephone Appointment System can be accessed through:
Phone Appointment Reservation.
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.