WHO is Open Enrollment for? ONLY for those with MAJOR PRE-EXISTING CONDITIONS who need an ACA/Obamacare/BCBS Plan

Open Enrollment depends on if you are choosing between an ACA Plan OR a Non-ACA plan. Those of you with NO MAJOR PRE-EXISTING CONDITIONS, you can enroll ANYTIME during the year! You would sign up for a NON-ACA/Obamacare Plan (major medical). Many carriers have Non-ACA Plans like United Healthcare, National General, Aetna, etc.

Those of you WITH major pre-existing conditions (heart disease/stroke, cancer, chronic obstructive pulmonary disease (COPD), diabetes, human immunodeficiency virus (HIV), substance abuse or for people who need maternity care or invitro fertilization), have open enrollment this year ONLY from Nov.1-Dec. 15. The only time OUTSIDE the yearly Open Enrollment Period when you can sign up for an ACA insurance plan is if you’ve had a qualifying life event, including losing health coverage, moving, getting married, having a baby, or adopting a child. Only 1 carrier offers ACA plans and that is BCBS. The Marketplace online (healthcare.gov) ONLY sells ACA PLANS through BCBS.

Non-ACA Plans were created for people who have NO major pre-existing conditions. Major pre-existing conditions are heart disease/stroke, cancer, chronic obstructive pulmonary disease (COPD), diabetes, human immunodeficiency virus (HIV), and substance abuse. What are the benefits of these plans?

-Nationwide PPO (excellent coverage for doctors, office visits, hospital stays-(over 175 hospitals), surgeries, and prescription drugs)
-Lower deductible and out of pocket costs
-Fully customizable (you choose how much you want to pay for your monthly premium, deductible, etc.)
-½ the cost of an Obamacare plan
-Sign up anytime and cancel anytime during the year
-Multiple carriers who offer Non-Obamacare

Obamacare Plans were created for people with major pre-existing conditions (heart disease/stroke, cancer, chronic obstructive pulmonary disease (COPD), diabetes, human immunodeficiency virus (HIV), substance abuse or for people who need maternity care or invitro fertilization. What are the advantages of Obamacare plans?

-Every legal US resident is eligible for an Obamacare plan
-There are no medical questions in order to qualify
-Depending on how a family income compares to the Federal Poverty level, family size, and how much healthcare insurance costs where you live, individuals and families can qualify for a subsidy

The disadvantages of Non-Obamacare Plans are:

-Doesn’t cover major pre-existing conditions; HOWEVER,if you do get sick while on Non-Obamcare, you can switch to an Obamacare Plan during open enrollment
-There are a few medical questions that a new client needs to answer
-The plan is only available to healthy individuals who have no major pre-existing conditions
There ARE a few disadvantages of having an Obamacare plan as well.
-There is only one carrier that offers an Obamacare (which does increase your premium somewhat due to no carrier competition)
-The networks are limited to only counties and cities
-If you get sick or hurt out of state, your plan will not cover 100% of your bills
-These plans are mostly HMOs which means these plans are not portable

Because everyone qualifies for an ACA plan, the premiums are very costly due to the many sick individuals on these plans. There is a shared cost to help people with surgeries, medications, and more you do not get to customize your plan meaning you do not get to choose your monthly premium, deductible, etc.
Open enrollment is only once a year between November 1 through December 15

After comparing the Non-Obamacare plan to an Obamacare plan, you can see that individuals with MAJOR pre-existing conditions only have ONE choice and that’s to get Obamacare. Healthy individuals with NO major pre-existing conditions have a choice between an Obamacare plan and a Non-Obamacare plans. This is not a knock against Obamacare plans, but they are very expensive, very limited networks, one provider in most states, and high out of pockets. In addition, without what is called a qualifying life event, you cannot get an Obamacare plan until Nov. 1st 2017. Which plan works best for you?

Top 5 Biggest Problems with ACA Plans

Who were ACA plans created for? ACA plans were designed only for people with major pre-existing conditions like heart disease, cancer, COPD, diabetes, etc. and those who are in need of maternity care. ACA/ObamaCare makes health insurance guaranteed issue meaning you can’t be denied health status, age, gender, or other factors. Just because insurance is guaranteed issue doesn’t mean you can’t be charged more for certain factors, although the ACA limits this as well.
However, ACA plans do NOT benefit HEALTHY individuals with NO major pre-existing conditions. Healthy individual and families have MORE healthcare insurance options than those who are sick. Those with no major pre-existing conditions can get Major Medical Non-ACA plans. Below are the top 5 biggest problems with ACA plans.

1.) Narrowing Networks- What if you do have cancer or heart disease? Wouldn’t you want to have the option to go to a great hospital for better care? Most of America’s best hospitals in the
National Comprehensive Cancer Network are not covered in most of their states’ exchange plans, and an American Heart Association study found that only a few insurance plans found on the
exchange included access to the specialists essential to diagnose and treat stroke – one of the most disabling and deadly diseases in the United States. The ACA plans are now HMO plans not
PPO plans.
2.) Skyrocketing Premiums- in 2018, ACA plans are increasing an average of 25%-53% depending on which state you live in. Millions of people will NOT qualify for subsidies.
3.) Lack of Insurance Carriers-Many carriers have pulled out from selling ACA Plans like United, Aetna, Anthem. etc. BCBS is one of the very few selling ACA plans.
4.) Increasing Deductibles-Health insurance deductibles will be increasing at rapid rates. What’s alarming is these deductible increases are happening at the same time premiums are skyrocketing.
5.) Small Businesses No Longer Offer Insurance-Over 4 million people lost their employment-based health insurance this past year. Many businesses found it more cost-effective to pay the penalty and let their employees purchase their own health insurance on the exchange.

Announcing a New Product from United Healthcare Insurance

We are excited to announce that United Healthcare Insurance has rolled out a new product/insurance plan!! Listed below are a few highlights/features and benefits for patients. Please contact us for more information.

  • Choose ANY licensed doctor or hospital in the country.
  • There is no lifetime maximum benefit.
  • No coordination with other forms of insurance, which means you’re paid a fixed amount for a covered service regardless of when or how other health insurance you may have pays the claim.
  • FIXED Rates for as long as you keep the plan
  • ZERO DEDUCTIBLE and ZERO CO-INSURANCE = Day One, Dollar One Benefits!!!

Rollover Benefit

If you can rollover your unused data, why not your doctor visits too? This unique benefit allows you to rollover any unused doctor office (illness or injury) or urgent care visits remaining at the end of a calendar year to the next calendar year. A maximum of 5 visits are allowed to rollover.

Wellness/Preventive Care

Services eligible under this benefit may include the following: annual physicals, immunizations (other than a flu shot), mammograms, and blood screenings.

Hospital and Surgery Benefits

Unlimited Hospital Stay with 25% yearly increase, with in-hospitalization benefits up to 5 years, and Surgical Benefits Tiers 1-4.

Drug Coverage

Coverage for Brand Name and Generic Drugs