Say “I do” to healthcare

by Robin Dorner
Editor in Chief

Regardless of what you think about the Affordable Care Act (ACA), it’s here to stay. The ACA – a.k.a. “Obamacare” – is the law of the land. The recent decision on marriage equality from the United States Supreme Court (SCOTUS) increases the opportunities for LGBT citizens gaining access to healthcare.

Getting married is a major milestone involving many changes – living arrangements, name changes, finances, taxes and a very important change could be your healthcare. Marriage opens the ACA to people to purchase healthcare outside of the open enrollment period.

“There are several SEPs (special enrollment periods),” said Brett Casey, a Licensed Insurance Agent with HealthMarkets Insurance Agency. “Getting married, divorced, moving, being Native American, losing insurance, being denied Medicaid, plus several others.

“It's actually pretty easy to qualify for most people,” adding that there are several options available.

Special enrollment periods vary based on the reason for qualification.

Marriage: If neither person has coverage going into a marriage, Casey said, “They are both eligible for a new plan, or just one can get a new plan. Here is where they qualify for the SEP too, and may qualify for subsidies or discounts based on their income.”

He added, “If one spouse already has coverage through an employer and the other has no coverage, the other can sign up for a new plan individually. It will have no pre-existing conditions and no out-of-pocket maximums. And again, they may qualify for a subsidy discount on the plan based on income.” They should also check to see if the uninsured spouse could be covered by the insured spouse’s employer plan.

If one spouse is already enrolled in ACA and one is not, they can still change their plan or enroll in a new plan when getting married. “This is because of the SEP (Special Enrollment Period). All of the rules and options above would apply too.

“The ACA plans really are great plans,” Casey added enthusiastically.

Subsidies: The U.S. Supreme Court ruling on the Affordable Care Act means that more than 80,000 Oklahomans can continue to receive federal subsidies to help them pay for health insurance. This means that “Obamacare” is still the law of the land for Oklahoma.

“It appears this law is not going anywhere anytime soon,” touts this Licensed Insurance Agent. “I wouldn’t base any insurance decisions over speculation of the future, the most important and relevant factor is what’s available right now. The Supreme court has established that Oklahoma’s subsidies are not changing.”

Rates: Casey said that generally, there are increases in rates every year. “It looks like a couple of new carriers are coming into the market next year. Rates are based on participation and claims in a certain zip-code, county, or state. However, it is important to remember that over 80 percent of Oklahoma is subsidy-eligible. Basically, it doesn’t matter how much the cost of the plans are for those that are subsidy eligible, because the amount they can spend on insurance is capped for certain plans.”

Casey is certified to help on or off the exchange (aka the Health Insurance Marketplace or healthcare.gov), has access to 184 insurance companies and is able to help with dental, vision, life insurance, supplemental insurance, disability, etc. He is also licensed in Texas and Arizona as well, to help people find help in other states.

“I consider my job to each client is to find the plan that best suits them. I custom build the plans to fit their needs (doctors, hospitals, prescriptions, their budget, etc.) and my services cost them nothing.”

Getting married or have other ‘qualifying’ factors and need help with ACA benefits (“Obamacare”)? Contact Brett Casey at (405) 413-5384 or visit www.HealthMarkets.com/brett.casey (brett.casey@healthmarkets.com).

Open Enrollment for 2016 coverage starts November 1, 2015 and ends January 31, 2016.

The Gayly – August 4, 2015 @ 11am.