Now that open enrollment for ACA plans on the Federal Marketplace and direct enrollment for open enrollment plans offered off-Marketplace by carriers like Florida Blue has ended, individuals can qualify for ACA plans only if they have a qualifying life event that provides them an opportunity for a special enrollment period to purchase an ACA plan.
In general, short-term medical and limited benefit defined benefit plans will be the only alternative to buy insurance coverage for those who can’t qualify for a special enrollment period or for those who do qualify but can’t afford an ACA plan.
However, short-term medical plans have limitations because they generally don’t provide outpatient prescription drug benefits, preventive care, and in most situations provide coverage only after the deductible is met. They also aren’t offered in all states (California, Maryland, Massachusetts, New Jersey, New York, Vermont, and Washington don’t permit short-term plans), some other states place significant limitations on short-term medical plans, and some short-term carriers don’t offer plans in some states that permit such plans.
Also, short-term medical plans usually require an individual to pass underwriting questions if the policy term has expired and the subscriber would like to renew the policy; in addition, such plans can be written only for a maximum of 364 days (lesser periods in a number of states).
We’ve just become aware of a plan that offers minimum essential coverage (“MEC”) that complies with the Affordable Care Act, provides preventive care coverage, includes benefits like office visit co-pays and hospitalization coverage, has no deductible, and a $3,150 individual and $12,700 family out-of-pocket maximum.
Premiums are 35 to 50% lower than for off-Marketplace Affordable Care Act plans, and the plan uses one of the largest PHCS networks (this network is significantly larger than for MEC’s offering more limited coverage like preventive care benefits only or preventive care coupled with office visit co-pays and diagnostic testing).
Potential enrollees must pass limited medical underwriting, but once they pass that underwriting the plan continues without the requirement to pass additional underwriting questions.
The plan is designed for single individuals making $35,000 or over (and higher amounts for families) and who qualify either for small or no advance premium tax credits (subsidies).
Here is a
of an advertisement that will begin to be offered nationally shortly.
We are appointed to sell this plan, and can write this plan in all 50 states and DC. Please call us at
or email us at
for details and to enroll in this plan.