Frequently Asked Questions
Check out some of the most frequently asked questions we receive about medical insurance, health coverage, and the Shoreline team.
Is there an additional cost to having an agent?
No. In fact, if you have a good health insurance agent, you will most likely save money. The premiums are the same no matter if you use an agent or go directly to the carrier, so you might as well have someone with expertise walk you through the process and service your policy going forward.
How far in advance should I start looking for private health coverage?
Ideally, you should start searching for private health insurance coverage 2-3 weeks in advance as there is processing time once your application is submitted. In some cases, your application would need to be in by the 15th of one month in order to have it start the 1st of the next month.
Do I have to purchase coverage through MNSure?
No. However, if you qualify for a subsidy and would like to pursue that option, then you would need to purchase your “Qualified Health Plan” through MNSure. If you don’t qualify for a subsidy, then you may find the process to acquire private health coverage much easier by purchasing direct with the insurance carrier.
Are there differences in the plans available through MNSure vs. Off Exchange?
Most health plans available on MNSure can be purchased directly through the insurance carrier; the benefits and rates would be the same regardless of how you apply (unless you qualify for a subsidy/Advance Premium Tax Credit). However, there are some additional plan options that can only be purchased outside of MNSure and vice versa.
*More changes to come in 2015
Can I qualify for health coverage with pre-existing conditions?
Yes! Due to the Affordable Care Act, all health insurance plans are now guaranteed issue with no pre-existing condition limitation. However, you must enroll during the Open Enrollment Period or have a qualifying event if outside of OEP in order to acquire a private health plan
When is the next Open Enrollment Period?
The specific dates for Open Enrollment Period have varied since the ACA has rolled out in 2014. Typically, Open Enrollment runs from Nov – Feb with plan changes going into effect as early as Jan 1st of the following year.
What is a Special Enrollment Qualification?
A Special Enrollment Qualification is a loss of minimum essential coverage. For example, coverage ends because a job is ending or a dependent is turning 26. This does not include loss of coverage due to failure to pay premiums, including COBRA premiums.
Other situations that may qualify include:
- Divorce – if losing benefits as a result of the divorce.
- Birth of a child, adoption, or placement for adoption or foster care.
- Gain citizen, national, or lawfully present status.
- Change in circumstances causing new eligibility or ineligibility for advanced premium tax credits or cost-sharing reductions.
- Change in enrollee’s permanent address
- Being an enrolled member of a federally recognized tribe.
- MNsure determines that an error was made by MNsure which resulted in an error with the consumer’s prior enrollment.
Can I make a change to my plan outside of Open Enrollment?
No, unless you have a qualifying event. See list of SEP qualifications above
Is the deductible on a plan year or a calendar year?
The deductible runs on a calendar year, so it will reset on January 1st regardless of your plan’s effective date
Can I make contributions to my HSA when enrolled in Medicare?
In most cases, no. Having Medicare makes you ineligible to make HSA contributions, unless you meet the following criteria: You must be enrolled in an HSA-qualified plan through your employer, and you must also waive Original Medicare coverage, including Part A (Hospital).
When do I need to stop making contributions to my HSA if I’m enrolling in Medicare?
If you are enrolling in Medicare during your Initial Election Period (IEP = 7-month window surrounding your 65th birthday month), you may make a pro-rated contribution to your health savings account equal to the number of months you were enrolled in an HSA-qualified plan within the calendar year.
If you are enrolling in Medicare using a Special Enrollment Period (outside of your IEP window), the same rules apply as above, however you must backdate your pro-rated contribution by 6 months from your Medicare effective date.
Do I need a Part D plan if I don’t take any medications currently?
Part D is optional under Medicare. However, if you don’t enroll in Part D when you first become eligible for Medicare, you could be subject to a lifetime late enrollment penalty. The penalty is 1% of the national average of Part D premiums, which are dictated by Social Security and fluctuate each year, for each month you’ve gone without credible Part D coverage.
What’s more, you can only sign up for Part D during certain times of the year. So, if you don’t sign up when you first become eligible, you may not be able to sign up until the following year and potentially incur the penalty.
Do I need Medicare Part A & B if I’m still working?
No, you don’t need Part A or Part B if you’re still working. You can waive both without penalty if you’re enrolled in a credible plan through your employer. Most employer health plans meet Medicare standards for credible coverage. Check with your HR specialist or plan administrator to find out if your employer’s plan meets these standards.
How do I know if I should keep my employer’s plan or enroll in Medicare?
It all comes down to cost of coverage. For most people, Medicare offers a lower premium cost and provides better coverage than a commercial employer plan. But this isn’t always the case. Here are a few scenarios in which an employer plan might be more attractive:
- The working spouse is eligible for Medicare and carries a younger spouse on an employer plan. If the working spouse were to go on Medicare, the dependent spouse would be forced to go on COBRA or seek coverage in the private market.
- If your employer is contributing a significant amount to premiums.
- If you’re already met your plan deductible, it might make sense to ride out the year on your employer plan.
- If you require expensive medication and your employer’s plan offers a 100% prescription co-pay once maximum out-of-pocket costs are reached. There isn’t a Medicare plan that offers this benefit.
Can I have a Health Savings Account with any high deductible plan?
No. You must have a qualified H.S.A. plan. Some high deductible plans have copays or first dollar benefits which will exclude them from being eligible to use a Health Savings Account.
Will I lose the money in my H.S.A. at the end of the year if I don’t use it?
No. That money is your money and it will roll over from year to year..
Can I use my H.S.A. to pay for premiums?
No. It can be used for medical, dental, and vision related expenses, but it can’t be use to pay your health insurance premiums (unless they are Medicare premiums).