Most insurance companies only sell health plans during an open enrollment period that starts in November. But there are other options if you need a new plan now.
1. Buy a plan from an insurance company or HMO.
You can buy an individual plan (all HMOs in Texas) if you qualify for a special enrollment period. Typically, you qualify when one of the following occurs: you lost your group coverage, marriage, divorce, or the birth of a baby. You normally have only 60 days from the special event to apply for coverage under a special enrollment.
You might qualify for a subsidy to help pay your premium. However, remember if you get a subsidy based on your current income (limited or no work), when your income goes up, you’ll need to notify healthcare.gov or you might have to repay the subsidy.
Short-term plans or alternative health plans cover certain illnesses, or are used to cover you until you can get another kind of plan. Know that most alternative plans don’t cover all injuries and medical conditions, and may not pay for all the care you need. Before you buy one, find out exactly what it does—and doesn’t—cover.
Short-term health plans
Short-term plans last 12 months or less, but sometimes can be renewed up to 3 years. They usually offer fewer benefits and have lower coverage amounts than major medical plans. These typically are designed to cover a new sickness or accident, and don’t pay for pre-existing conditions (i.e. no treatment in the previous 5 years).
These types of plans are exempt from the definition of individual health insurance coverage under ACA provisions that apply to the individual market. They have limitations on coverage (e.g. no maternity coverage), and don’t have all of the same mandates, such as unlimited benefits maximums. Most are covering anything related to COVID-19.
When a short-term plan ends, you’ll have to buy a new plan. If you’re sick, you might not be able to get another short-term plan.
Limited benefit health plans
These plans are sometimes called Mini Meds, and are marketed as an ACA alternative with a PPO. They may include a PPO and provide a schedule of benefits that pay a certain amount per day or treatment, and are capped or limited to a maximum amount. (Often a company selling these plans will address this limitation by selling additional coverage for critical or specified illnesses.)
These plans are underwritten based on good health and have some form of pre-existing condition limitation, which means anything you’ve been previously treated for is not covered for a period, normally 12 months. If the plan is guaranteed issue with no pre-existing condition, make sure you’re not just buying a discount plan.
They may also offer copays and RX benefits; however, they don’t include the “essential minimum health benefits” required by the ACA.
These plans can be an option, however you need to really understand the limitations and coverage, as you could be responsible for tens of thousands of dollars—even though you’re covered if you had a major accident or illness.
Subscription health plans
Subscription plans are also known as direct care or concierge care plans. Members typically pay a monthly or annual fee to use a doctor or service included in the plan. There may be other fees for each visit, lab work, or other services. If you need care that the subscription plan doesn’t cover, you might have to pay the full cost yourself.
Faith Based and Health Share Groups
These types of plans are not insurance, and should not be considered a substitute for insurance. They are arrangements where you join a group and pay or contribute a monthly amount to the plan. After a deductible, you submit your medical bills and are reimbursed from the funds available, or by others making additional contributions to cover your bill.
These arrangements have stricter guidelines than traditional insurance companies on which procedures are eligible, and there’s normally a lifestyle guideline where a member agrees to live a certain way: abstain from tobacco use, abuse of alcohol or prescription drugs, illegal drug consumption, and sex outside of marriage. The payments of medical bills through these arrangements are not guaranteed in any way; each member is solely responsible for the payment of his or her own medical bills at all times.
If you understand how these plans work and their limitations, they can be a less expensive option than ACA plans.
2. Continue the plan you had at work.
If your health coverage is ending because you lost your job, you can continue your plan for 18 months under the federal law, COBRA. If the employer has under 20 employees, then Texas law provides for State Continuation for up to 9 months. If you continue your plan, you’ll have to pay the premium to your former employer or via an administrator. If you pay via an administrator, it may add 2% to your premium for a billing charge. Ask your former employer about these options.
3. Get on your spouse’s or parent’s plan.
Check with your spouse’s employer to see if you can get on its plan. If you’re under 26, you can get on your parent’s health plan—even if you don’t live with your parent or aren’t claimed as a dependent. You could have a full-time job, be married, or going to school. Ask your parent to talk to his or her employer or its insurance company about how to add you.
4. Government Programs
The following government programs provide health coverage, but you need to qualify for it. Qualifications are mostly based on income.
- Children’s Medicaid or CHIP for children and pregnant women
- Medicaid for some people who can’t afford private coverage
- Medicare for people over age 65 and people with disabilities
If you would like to receive more information or would like to discuss the insurance options available, please contact TDA Financial Services Insurance Program at 800-677-8644 or visit tdamemberinsure.com.