Healthcare Insurance & Healthcare.Gov Questions of the Week

Local insurance broker, Dusty Silva, RHU, CIC, CISR is helping the Frontiersman’s readers better understand the world of healthcare and of the HealthCare.Gov marketplace to make the best decisions for their families.

With over a three decades of experience, Ms. Silva has been assisting clients in understanding the complexities of insurance. From personal and commercial lines to life and health coverage. Having navigated the ever-changing landscape of health insurance including the pivotal Affordable Care Act shift in 2010, Dusty continues to provide clarity in the confusing insurance marketplace.

Ms. Silva will answer a number of healthcare and HealthCare.Gov questions each week, so use the form at this link to submit yours here.

1) What is the open enrollment timeline or window? Can I sign up outside the window?

Open enrollment is 11/1-12/15 for a 1/1/24 effective date. Open enrollment continues 12/16-1/15 for a 2/1/24 effective date.

After open enrollment you can apply for coverage if you qualify for a special enrollment period. You can go to healthcare.gov for a complete list of situations that would qualify for a special enrollment. Here are some situations that may qualify for special enrollment period:

Involuntary loss of qualifying health coverage in the past or future 60 days. Became eligible for a QSEHRA or ICHRA in the past or future 60 days. Household income under 150% of the federal poverty level

American Indian or Alaska Native (ANCSA) Shareholder

Leaving incarceration

Becoming a US citizen

2) I moved from the lower 48 and am having a tough time sorting out what options I have for healthcare providers. What are my options for providers and is the process so complicated that I need a local expert or broker to help me through the process?

We have 2 insurance companies that offer qualified individual health plans through the marketplace “healthcare.gov”. It is important that you review the preferred provider networks included for each company and within all of the plans. A broker can help make this process easier! You can find a broker by going to the healthcare.gov website and click on” find local help”, enter your zip code and select agent/brokers. This will provide a list of brokers to help you!

3) I was on Medicaid, but am now newly employed and have had a change in income...is it a good idea to cancel that coverage first or wait until my new coverage kicks in?

You will need to update your information with the public assistance office with the State. The state will review your information to determine if you still qualify for the program and notify you regarding eligibility. If your Medicaid coverage is terminated due to a change in income that will trigger a special enrollment period (involuntary loss of other coverage) to buy marketplace coverage and answer household income questions to determine if you qualify for advance premium tax credit savings.

4) What is a “Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)?” and “Individual Coverage Health Reimbursement Arrangement” (ICHRA) Do I need it? How do I find out if I have this?

A QSEHRA is a HRA (Health Reimbursement Arrangement) that can be offered by small employers with under 50 employees. A QSEHRA is used to reimburse employees individual health insurance premiums. You will need the letter from your employer to answer questions on your marketplace application. It is possible to receive both the QSEHRA reimbursement and marketplace advance premiums tax credits. The advance premium tax credit will be reduced by the amount of the QSEHRA benefit.

A ICHRA is an Individual Coverage Health Reimbursement Arrangement that can be offered by employers of any size to reimburse qualified individual health insurance premiums. You will need the letter from your employer to answer questions on your marketplace application. If the ICHRA is affordable you will not qualify for advance premium tax credits on the marketplace.