Marketplace Exchange – Have You Missed Open Enrollment?


Have you missed the open enrollment? It’s not too late! The marketplace exchanges are closed, but that doesn’t mean you cannot still get medical coverage. Below we will discuss how short term medical plans, critical illness, accident fixed-benefit coverage, critical illness coverage, fixed-indemnity insurance plans, and special enrollments are five viable options within the market to help you get covered.

Short Term Medical Plans[1] (STM) offer coverage when there are transitional periods in life that can leave you without medical coverage for a brief time. STM provides affordable temporary health insurance to protect you and your family. You should consider purchasing STM if you are concerned about protecting yourself from the potentially high medical costs associated with an unexpected sickness or injury. STM is ideal for:

  • Individuals between jobs
  • New hires
  • Early retirees
  • Recently naturalized citizens
  • Recent college graduates

With STM you have the freedom to receive treatment from doctors and hospitals of your choice without incurring out-of-network penalties. STM gives you peace of mind.

Accident Fixed-Benefit Coverage[1] pays cash right to you, helping you catch up financially from days off work and pay expenses other plans don’t pay (like auto and medical deductibles). You get a set cash benefit for each covered injury and service multiple benefits that really add up and pay:

  • Immediately (no waiting period)
  • Over and above any benefits you receive from any other plan
  • No matter what doctor or hospital you choose
  • Even while you recover (including those for follow-up treatment and physical therapy)
  • With no overall annual or lifetime limits (no matter how many accidents you have)

Critical Illness Coverage reduces the potential financial impact of critical illness on your family and your future. When you choose critical illness coverage and face a critical illness, you are eligible for:

  • Lump-sum cash benefits upon diagnosis or treatment —above any benefits you receive from any other plan
  • Freedom to visit any doctor or hospital you want and use the cash any way you need
  • No need to worry about deductibles, coinsurance, copays or preauthorization
  • No additional application or underwriting when you add Critical Illness Coverage to an Assurant Health
  • Individual Medical plan

Fixed-Indemnity Insurance Plans[1] have limited benefits and are not major medical insurance plans. Fixed indemnity benefits are provided for covered periods resulting in medical treatment. Benefits received from fixed-indemnity insurance plans are paid in specific amounts for coverage periods without regard to the cost of services rendered. The policyholder; however, may have amounts left over to pay after the plan pays the fixed benefits.

Special Enrollments are triggered by a qualifying event. When eligible for a special enrollment, you are able to apply for major medical coverage with all the carriers on and off the exchange. A person with a qualifying event has a special enrollment window of 60 days to apply for coverage. Some of the ways in which you may qualify for special enrollments are:

  • Birth or adoption
  • Marriage
  • Loss of employer sponsored health insurance as a result of:
  • Termination of employment
  • Employer reduces work hours to the point where you no longer are able to be covered by the health plan
  • Employer’s plan decides it will no longer offer coverage to a certain group of individuals (for example, those who work part time)
  • Termination of employer contributions
  • Loss of coverage for a dependent child who has reached the dependent limiting age
  • Exhaustion of COBRA
  • Loss of eligibility for Medicaid or CHIP
  • Divorce/Legal Separation
  • Loss of retiree coverage due to former employer filing for bankruptcy protection
  • Death of the policyholder
  • Incur a claim that meets, or exceeds, a lifetime limit on all benefits under existing coverage
  • Gaining status as a citizen, national, or lawfully present individual
  • No longer incarcerated
  • Loss of coverage due to a permanent move outside of the plan’s service area
  • Plan is due for renewal outside of open enrollment (30 day window)
  • Change in income that results in individual being determined newly eligible or newly ineligible for tax credits or has a change in eligibility for cost-sharing reductions

Health Care Reform can be a confusing process, but you do have options. The five opportunities we just outlined can work for you, but you must seriously consider the needs and wants of your desired coverage. Each is a viable option, but with drastic differences. Be sure to do your homework, and give Todd McLaughlin, your trusted Apex Benefits advisor, a call with any questions you may have about these products or health care reform in general.

Todd McLaughlin, Advisor – 317-806-5149 –

[1] Plan is not a major medical plan and should not be used as a substitute for major medical. Under the Affordable Care Act this plan is not considered to have all the minimum essential benefits which leaves you exposed to the tax penalty unless otherwise excused from penalty due to a valid waiver. In 2014 the penalty is 1% of your income or $95, whichever is greater.
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