What is the open enrollment and what dates does it cover?
It is the official enrollment period throughout the United States where people will have the opportunity to apply for medical coverage through the health market and the Affordable Care Act, better known as Obamacare.
From November 1 to December 15, so that the person can have medical coverage starting January 1, 2025. But it is open until January 15, obviously if you apply for coverage in January, your insurance begins on February 1.
What options do people have who miss the window of open enrollment?
There is also a special period that is the entire year, if the person wants to make a change of residence, if they had another child, or a child left their taxes, if they got married, divorced, if their income changed, for example, there Rate certain circumstances that have changed in your life. It is most advisable for the person to call an advisor, because he or she can see if that person qualifies for a special period.
Why do some people avoid going to the doctor?
In this country, the issue of health is complicated because we know that it involves high costs, and in case of emergency, the person is afraid to go to a hospital or an emergency room. Because there are two concepts: Emergency room and urgent care. The emergency room is when you go to the hospital. and the urgent care They are those rapid emergency centers, where if the person has insurance, the co-payment will be very low: 5, 15 dollars. But if you go to an emergency room you can expose yourself to a Bill (bill) of $2,000, and without insurance, up to $20,000. It is a complicated issue because many people are afraid of going to the doctor.
What options do low-income people have?
This law means that qualified people can apply for medical coverage with a tax credit. This tax credit will allow you to pay for coverage at a very low price, compared to private coverage as such. This will depend on the family unit on the tax return, if the family is made up of one person, four people, the income of that unit, and where the people live, that zip code, that county will also influence what coverage doctor will be the most suitable or have the best network in that area.
Are there new regulations this year?
I recently had a meeting where I was able to meet people who work directly with HealthSherpa (a platform for quoting and enrolling in health plans with the Affordable Care Act), and with the CMS, which controls absolutely all the law and regulations for so that people can register and so that advisors can register a person.
Previously, when registering, people had a period of up to three months to send their documents. For example, if a person wanted to apply for coverage and did not feel comfortable giving their social security number, or sending a photo of their residence or citizenship, they could send it directly to the health marketplace. In fact, the health market sent the client a letter with the limitations.
Now it’s not going to be like that. We are waiting for the official update, but they indicate that the person will definitely have to provide, from the moment of registration, their social security number. That’s a big change. Because due to not having provided that information, unfortunately many failures occurred, and they began to qualify people who did not qualify because they did not have the immigration status required to apply.
What advice would you give to people who have been in the country for a short time and are looking for health insurance?
The most advisable thing is that the person get a certified advisor specialized in the area, who is also a well-known person, it is recommended. A person, if they enter the health market alone, may not know how to manage the tables and cannot maximize the benefits as an advisor would.
We can review the provider network, see how well that company works in the area where the person lives, and there are various details regarding income. We help them qualify, take advantage of the tax credit, benefits, and have excellent medical coverage. We can determine, among the plans that the area offers us, if a plan will be better at the time of a hospitalization because the co-payment, or shared expense, that you will have is much lower, understanding that all medical coverage has shared expenses. When a Bill of a hospital, for an operation, could be 80,000 dollars, with that plan the maximum annual out-of-pocket expense would be paid, for example, which in many coverages is 1,700 dollars. We do an analysis prior to November 1, we see the network of doctors in the area that the person has, so that they have coverage that really works for them, and that in the event of an emergency they have the closest place to go.
A good advisor will explain to you: Yes, we understand that you want to pay the least for medical coverage, because you want to have the benefits, but this is based on how many people are on your tax return, how much income you are having annually, and how much you want to project in your future statement. Additionally, the person must have an immigration status; although student visas also apply, and people who have TPS, a work permit with temporary protection, and those who have applied for asylum can also do so.
What should we have on hand?
The most important thing is that people have their taxes on hand, to see their income, and qualify it correctly to avoid penalties when they file taxes. Because if the person does not report their income correctly, or the advisors do not do it well, and the person who is harmed is the client because they have to make a refund of the tax credit at the time they are going to declare the taxes. So it is a big responsibility that we as advisors have.
For those who already have a plan, should they consider changing their coverage?
In fact I always do it every year. I evaluate the provider network and review the best option in the counties where my clients are, and I make it super personalized. For example, if someone asks me if there is a way to improve their insurance—because every year they change, in price, benefits, copayments—I review what the best options are and tell my client if there is a better option, be it a cheaper monthly premium, a better deductible, or a more convenient out-of-pocket maximum. It is the ideal time for the person to evaluate their plan, how it went throughout the year, and decide to apply for other medical coverage.
What value does health have?
Health is the most important thing we must take care of. It is important, in fact, that the Hispanic community understands that in this country we must have control, regular medical checkups. We have seen so many diagnoses of very young people, children with diabetes, people with cancer at an early age, for not having that preventive checkup, which will help us take quick action. Without health we are nothing, we must take care of it.
A message for the community?
That they prepare for this period, that they always try to do it on time, many people leave this until the last minute, and it is advisable to do it from November 1, to avoid the risk of starting on January 1 unprotected.
