Can I still enroll for Health Insurance after Open Enrollment ends?

Normally health insurance companies will only allow you to apply for individual health insurance during the annual  “Open Enrollment”.  However, the Affordable Care Act still permits you to apply for new major medical coverage under certain special circumstances. Here is a list of the main “qualifying life events” which would allow someone to apply for health insurance after the open enrollment has ended: birth/adoption of a child, marriage, divorce, death of a dependent policyholder, loss of previous employer-sponsored health insurance coverage, exhaustion of COBRA insurance, or loss of eligibility for CHIP or Medicaid.

Additional reasons include: gaining status as a citizen, national or legally present individual, loss of coverage due to a permanent move outside of your plan’s coverage area, termination of a short-term (temporary) health plan, or change in income that affects eligibility for premium tax credits for Marketplace enrollment only.

Penalties for not having a “qualified” health plan for at least 9 months in a calendar year, will be assessed based on the number of months one is not insured with a qualified major medical plan. You can minimize or prevent this penalty depending on how many months you maintain at least the minimum essential coverage.

Based on adjusted gross household income, some low/middle-income applicants may be eligible for savings on their health insurance premiums, by applying through the Health Insurance Marketplace.   To be eligible for consideration, an individual’s gross adjusted household income must be between 100% – 400% of the Federal Poverty Level (FPL).  Even if they do not qualify for a premium tax credit, they could still apply for an “Off-Marketplace” regular ACA-Compliant health plan, without financial assistance.

Most insurance companies offer traditional qualified PPO plans, but rates are generally higher than last year. If having a more affordable health plan is a priority, many insurance companies also have HMO health plans available at lower rates. HMO plans are still qualified major medical insurance, but they have certain Network restrictions.

You can get answers about health insurance questions by contacting a licensed independent health insurance agent at  There are never any fees for quotes or other services.  An agent will assist you in choosing an appropriate, affordable health plan and help with the completion of your application.

Contact us at: or call (512)535-3556 and let us know how we can help you.  We are “Tejas” friendly and serve clients throughout the entire state!

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Were you ever declined for Health Insurance?

Are you one of millions of frustrated Americans who were told they did not qualify for traditional major medical insurance because of a “high-risk” pre-existing health condition?  Well as of Jan. 1, 2014, you can no longer be declined if you had/have Diabetes, Cancer, Heart Disease, Rheumatoid Arthritis, Alzheimer’s Disease, or any other serious health problem.  Additionally, new individual health plans will also provide benefits for Maternity.  (Maternity is not currently covered on individual health plans!)

On October 1st, you will be able to choose from a variety of affordable health plans, regardless of your health!  That’s right, “Open Enrollment” through the Health Insurance Exchange program will begin on that date, and coverage for those health plans will become effective Jan. 1, 2014.

The determination of rates for these new “Qualified Health Plans” (or QHP’s) will only consider the following criteria: age, geographic location, single/family status, and tobacco use.  No exclusion riders or additional rate-ups can be imposed due to a person’s build (height/weight ratio), gender, prescription drug use, or health issues!

The Affordable Car Act requires these new QHP’s to be offered with several different deductible levels and coinsurance choices.   These non-grandfathered plans are required to provide a minimum of 10 Essential Health Benefits (or EHB’s).  You can refer to this list of EHB’s by visiting this link on the web site: .   No “lifetime dollar-limits” or “annual dollar-limits” of benefits will be permitted as of Jan. 1, 2014.

Applicants for these certified QHP’s through The Exchange may qualify for a premium tax credit.  Subsidies will also be available through a cost-sharing provision.  Individual/family household income will be considered for eligibility for these two types of assistance.  Eligibility for these premium-savings options will automatically be determined during the application process.

There will continue to be individual/family major medical insurance offered “Off-Exchange”, for those who do not choose an “On-Exchange” QHP, or employer-sponsored group insurance.  The new “Off-Exchange” plans must also provide the required minimum EHB’s, and accept ALL applicants regardless of health conditions, Rx use, gender, or build.

We can help you compare your benefits on your current health plan, and offer our insight and suggestions for your 2014 coverage options.  For additional details or for answers to your questions, contact a certified Exchange agent at by calling: (512) 535-3556 or e-mail at:

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Information About the New Health Insurance Exchange Program

Americans can enroll for health insurance through their State or Federal Insurance “Exchange” beginning on Nov. 15, 2014 through Feb. 15, 2015.  However, regular “qualified” individual and group plans will still be available “off-exchange”, and will satisfy the mandate for being insured.   The Affordable Care Act requires that everyone (with a few exceptions) must have qualified health insurance  After Jan. 1, 2014, or pay a fee/tax.  Each year the penalty, which is based on a certain percentage of one’s income, is scheduled to increase.  IRS will oversee the taxation.

Millions of lower-income Americans will benefit from participation with Qualified Health Plans (or QHP’s) offered through the Federal or States Exchanges.  Subsidies and premium tax credits will be available for those whose incomes are low enough to qualify.  Persons whose incomes exceeds the maximum qualifying amount, will still be able to find individual insurance “off-exchange”.  After Dec. 31, 2013, pre-existing health conditions will no longer cause any applicants to be denied health insurance, a major component of Healthcare Reform for Americans!

The health plans from the Exchanges will be Major Medical insurance, with a variety of deductibles and coinsurance percentages from which to choose.  Doctor visit “copays” will be included on many plans, and all plans will have a “maximum out-of-pocket” responsibility limit per year.  With HMO plans, there will be no benefit coverage for services which are performed at “Out-of-Network” facilities or by “Out-of-Network” providers (physicians, etc.).  These Networks will likely be smaller than most traditional PPO networks!  Be sure that you know whether you are choosing an HMO or a PPO health plan.  It will be indicated as either one or the other.  Not all major insurance companies will participate in the Exchange program in every area.  Ask a certified agent which companies will be available where you live.

Review your current insurance policy’s benefits summary and plan details!  It may be advisable that you consider enrolling in a new health insurance plan if your existing one was issued before Sept. 23, 2010.  Plans prior to that date will be “grandfathered in” and will not have to include those “10 essential health benefits” that will be required on plans issued Jan.1, 2014 and later.  For details about these newly mandated essential benefits, go to: .

Also, plans issued after Sept. 23, 2010 allow children up to age 26 to be included on a parent’s plan, and they cannot be denied coverage if they are under age 19, due to pre-existing health conditions.  (However, they can be assessed a higher rate due to increased risk factors.)  All plans issued after this date must provide coverage for one free annual preventive exam per person.

If you do not enroll in a major medical health insurance plan by the end of “open enrollment” (Feb. 15, 2015) you will not be able to get insurance through the Exchanges again until the “annual enrollment”.  You must, however, have health insurance coverage for at least nine months in 2015 to avoid the tax.  If you experience a “qualifying life event” (QLE), that exception will allow you to apply for health insurance within a certain short period of time.  Some QLE’s are: marriage, divorce, birth, adoption, death, loss of health insurance or a move outside of your current plan’s area.

“Certified agents” and “navigators” will be permitted to enroll you in a plan from the Exchanges.  After reviewing your current insurance policy, why not ask a helpful agent at to explain your options?  New individual/family “Off-Exchange” major medical plans will still be available for those who do not choose plans through the Insurance Exchange program.  There is no charge for our services and we can often generate quotes within 24  hrs.  Contact us at: (512) 535-3556 or through e-mail at: for further details.

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Lowering the Cost to Insure Your Family

When a business chooses to offer its full time employees health insurance, the employer must contribute a certain amount toward the monthly cost of that group plan.  The minimum contribution is typically 50%, and some larger companies may even pay the full premium for their employees.  When there are several plan options from which to choose, the employee may elect to receive coverage from a health plan which offers richer benefits than the basic plan.  In that case, the employee will be charged for the cost difference of the higher-priced plan.

Most companies will not contribute toward the premium for health insurance coverage for an employee’s dependents.  The employer must make such coverage available for the employee’s family members, but the cost of this additional coverage is usually the employee’s responsibility.  However, the rates for adding a spouse and/or children to an employee’s health insurance plan are sometimes unaffordable for many families.  This financial hardship sometimes leads to inadequate or no health care coverage for dependents.

If the employee’s dependents are healthy and have no pre-existing health conditions in their medical records, they could possibly qualify for an Individual Major Medical Plan for a more affordable rate.  This is especially true if those dependents are young, or if the family selects a plan with a higher deductible.  Healthy dependents can lower their price even more if they choose not to include certain benefits like doctor visit copays and prescription drug copays.

On January 1, 2014 a key component of the Affordable Care Act will go into effect.  Americans will be required to have health insurance, or they will be assessed a penalty.  Each year the amount of the fee increases from the previous year.

There will be an “Open Enrollment” for health insurance through Federal and State Exchanges (or health insurance marketplaces), beginning in October, 2013.  A variety of health plans with different deductibles and benefits will be offered through major health insurance carriers.  It’s a good idea to consider your situation, benefit needs, and budget limits now.

An independent insurance agent can help you objectively compare options for your family’s situation. has nearly 200 different options to choose from, offered through 8 major health insurance companies.  Call us at: (512) 535-3556 or send an e-mail to:  We’ll provide you with a fast, free quote comparison of plans that will best suit your situation.

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Higher Health Plan Rates in 2014?

If you wait until next year to purchase a health insurance plan in the individual market, you will likely pay a higher rate than if you choose one by Dec. 31st, 2013.  I will mention a few of the factors which will influence next year’s rates.

Currently, personal health plans are medically underwritten…underwriters review one’s health history to assess risks for coverage.  Those with the most serious health issues are typically denied coverage.  Due to this evaluation process, insurance companies minimize their odds of covering potentially large claims.  This means an insurer can offer a lower premium to healthier applicants who meet a certain standard of good health.

As you may know, on Jan. 1, 2014, no one can be denied access to health insurance because they have a serious pre-existing health condition.  All major medical health plans will be offered on a “guaranteed issue” basis.  Insurance companies will be faced with paying some extremely expensive claims as a result of this situation.  To help compensate for this added expense, rates for all new participants will be higher than today’s premiums.

Another reason that rates will be higher in 2014 is due to the new Essential Health Benefits mandate.  This requires an insurer to cover 10 benefit categories for all insurance plans starting in 2014.  This coverage is likely more extensive than what most American’s currently have.  Providing these additional benefits will increase the insurer’s expenses.  This added cost will be factored in when the new insurance rates are determined.

Premium subsidies will be available for those of low income, based on a percentage of the Federal Poverty Level.  Federal and State Health Insurance Exchanges will make several different levels of coverage available, and their rates will be structured accordingly.

If you would like more details about the impact that the Affordable Care Act may have on your future health care coverage, please read the other articles in my blog regarding healthcare reform.  This is an ideal time to review your current health insurance.  Decide if you want to renew it, or choose a new, more affordable, individual health plan before 2014 arrives! has nearly 200 different affordable major medical health insurance plans available.  Let us give you a free quote for an inexpensive health plan that will suit your particular situation and needs.  We offer plans from “A” rated major insurers only.  You won’t find lower prices for our plans anywhere else in Texas.  Please call us now at: (512) 535-3556 and let us become your independent Texas Health Insurance Agent!


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Adding “essential health benefits” will require increased premiums!

In a recent article I mentioned that health insurance rates will likely be higher after Jan. 1, 2014 when a major component of the Affordable Care Act goes into effect.  One significant reason is because health insurance companies will be required to provide coverage regardless of a person’s pre-existing health conditions.   Treatment for certain health conditions can cost thousands of dollars per month for specialist’s fees and brand name prescription drugs.  Those exceptionally high claims affect monthly premium costs.

 When someone applies for an individual health plan during the remainder of 2013, they will still be required to answer health questions to be considered for health insurance.   The healthier one’s medical record is, the more inexpensive their cost would be.  Conversely, having high health-risk factors can cause applicants to be “rated” with higher premiums, receive an exclusion rider for their health condition, or even be declined for coverage.  After Jan.1, 2014, no one can be declined for even the most serious (or most expensive-to- treat) health conditions.

Another reason premiums will likely be more expensive is due to the healthcare reform requirement for all health plans to include 10 essential health benefits or EHB’s.  The following is a list of those mandatory health benefits:

1. ambulatory patient services

2. emergency services

3. hospitalization

4. maternity and newborn care

5. prescription drugs

6. habilitative and rehabilitative services and devices

7. laboratory services

8. mental health and substance abuse disorder services, including behavioral health treatment

9. pediatric services

10. preventive and wellness services and chronic disease management. 

Some of these benefits are already included in many major medical plans which were issued in the last few years, specifically a free annual preventive exam.

 Insured small group plans and individual major medical health plans that are not “grandfathered” are required to cover EHB’s starting in 2014.  This obligation applies to all plans whether they are sold within the state or federal health insurance exchanges or outside of the exchanges.  All non-grandfathered health plans that cover EHB’s must provide a cap (or maximum amount) for member out-of-pocket expenses (in-network) for essential health benefits beginning on Jan.1, 2014.

 If you are not currently covered by an individual major medical plan, and you are not working for an employer who offers group health insurance, you will likely face higher premiums after Jan, 2014, when the health insurance requirements go into effect.  Fees will be assessed on the uninsured with the help of the IRS for collection! 

Get a quote now from an independent licensed insurance agent, while the current lower 2013 rates are still available.  Call at: (512) 535-3556 for a fast, free quote.  We can help you find an affordable health plan which will best suit your particular situation and budget.  You won’t find a lower price for our inexpensive plans anywhere else in Texas!



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The Affordable Care Act- Significant Provisions

On 3-23-2010, the Affordable Care Act became law. Since then a number of provisions of healthcare reform have already become effective, which I will discuss in a moment. However, the most significant element of this law will directly affect millions of Americans and their healthcare coverage on 1-1-2014. The law’s main intention is to make affordable healthcare available and accessible for every American. Each citizen will have the responsibility of choosing a major medical health plan. Financial assistance will be available for those whose incomes are within a certain percentage of the Federal Poverty Level.

Beginning in 2014, if you are already insured through individual health insurance, or an employer’s group plan, you can keep that coverage if you so desire. However, you will also be allowed to choose from dozens of options through either a State or Federal Insurance Exchange, if you prefer that alternative. As of this writing, it appears that Texans will probably use the Federal Exchange. Certain guidelines will apply, based on a person’s situation. If you do not choose a health insurance plan, you will be assessed a penalty, although there are a few exceptions.

In 2014, the penalty will be 1% of one’s income, or $95. In 2015 the amount increases to 2%, or $325, followed by 3% of one’s income or $695, in 2016. In each case the greater amount will be assessed, whether a percentage or fixed fee, with annual increases following thereafter. The penalty will be collected by the IRS, just like taxes.

Here is a list of some of the improvements to healthcare coverage that are effective now:

  • A “free” annual preventive exam; visit this link to review what is included
  • Another current provision of the ACA prevents an insurer from declining coverage to anyone under age 19, because of pre-existing health conditions.
  • Expanded coverage now allows a parent to continue to insure their young-adult children until age 26.
  • Adults who have been uninsured for at least 6 months and have been denied coverage because of certain pre-existing conditions, may now get coverage through the “PCIP”, or Pre-existing Condition Insurance Plan.
  • Lifetime limits on what insurance will cover have been outlawed.
  • The Act has also lowered the cost of many prescription drugs for seniors on Medicare.
  • Additionally, some small businesses with fewer than 25 employees can now get help paying for the cost of providing health insurance benefits. Small business tax credits will cover up to 35% of the employer’s cost to provide health insurance for their employees. Investigate this opportunity with your business advisor or tax consultant for details on how to participate and save money.

You can begin to compare a variety of health insurance plans for yourself or small business right now. Don’t wait until 2014 to find a top-quality health plan that will best suit your needs. Many major medical plans have recently experienced reductions in their premiums. One company will actually reduce your annual deductible if you don’t meet it, which is a reward for healthy applicants! This would be an ideal time to get several free quotes for more affordable health insurance.

Licensed independent insurance agents can help you choose the ideal plan for your goals…they are not restricted to offering you insurance plans from just one insurer. This flexibility, along with their experience and knowledge, can increase your range of choices, benefits and prices. They are not obligated to promote a certain insurance company’s products, and can therefore offer their clients a more objective assessment of each plan’s advantages and drawbacks!

Contact to receive personalized customer service from a licensed independent health and life insurance representative. Your unique insurance objectives will be the focus of any health insurance plans that we recommend for your consideration. Based on one’s particular goals and budget, we will find the best possible health plan for our client.

We can also provide coverage for these other types of health insurance supplements: Dental, Vision, Life, Critical Care, Accident, Disability, Cancer, and Long Term Care. If you would like to save for your retirement, we can assist you with tax-deferred annuities, as well.  Please call us at: (512) 535-3556 or send an e-mail to: for your fast, free quote. We serve the whole state of Texas, and want to be YOUR local agent!

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