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Are You Perplexed, Bewildered, Dazed, And Confused About the Health Insurance?
Are you under 65 and considering retirement –
curious (and terrified!) about health insurance costs in the individual market?
Have you just lost employer coverage?
Are you self-employed?
Turning 26 and aging off your parent’s health insurance?
Affordable Health Insurance for Families & Individuals in Maine
Are you under 65 and considering retirement—curious (and terrified!) about health insurance costs in the individual market?
Have you just lost employer coverage? Are you self-employed? Turning 26 and aging off your parent’s health insurance?
Contact The Vachon Agency, your ally in obtaining individual health insurance, and allow us to assist you in obtaining the required protection. Our top priority is your health.
Individual Health Insurance
The Affordable Care Act (ACA) is Complex. We’re Here to Help You Handle It All.
The Affordable Care Act (ACA), also known as “Obamacare,” was signed into law March 23rd, 2010. It changed the face of individual health insurance—what the plans cover, when people can purchase health insurance, and how people pay for it. Under the ACA, the Federal Government determined that only “Qualified Health Plans” could be offered to consumers.
Qualified Health Plans must offer ten essential health benefits, include $0 cost preventive care, cannot deny coverage for pre-existing conditions, and cannot cap healthcare benefits received/year or lifetime. The insurance price increased because more is covered in these health insurance plans. To make this affordable for consumers, the Federal Government offers “Advanced Premium Tax Credits” to help lower the cost of your monthly premium.
Today, when you shop for health insurance, your monthly premium is based on five key factors: Your age, your zip code, your smoking status, your income, and the size of your household.
The purchase of health insurance and the premium tax credit eligibility is determined through a health insurance marketplace, also known as an Exchange. At this marketplace, you can one-stop shop for a plan. The premium you pay is based on your income. In 2022, Maine opened its state exchange called CoverME.
If you need assistance paying for health insurance you can visit CoverME by clicking the button below. While on CoverME you can designate your Agent to represent you. If you choose to have me represent you, please register me as your agent
(select "Karen Vachon") on your CoverME account, and complete the CMS Consent Form by clicking the button below.
More on Individual Health Insurance
Key Points About ACA Insurance. We’re Here to Help You to navigate the process.
Here are some key things you need to know about the Under-65 Individual Health Insurance Market.
1. November 1 – January 16th is the open enrollment this year. These dates have changed since the rollout of the ACA. However, it is essential to know that you can only enroll in health insurance for the new year during the open enrollment period unless you have a “qualifying event”.
2. “Qualifying Events” include the following:
- You moved from or to another state or plan service area.
- You get married or divorced.
- You lose employer coverage due to job loss.
- You turn 26 and age off your parent’s health insurance plan.
- You get pregnant.
- The birth or adoption of a child.
- You lose MaineCare, Medicaid, or CHIP.
3. “Qualifying events” entitle you to a Special Enrollment Period (SEP)
The SEP will give you 60 days to enroll in a new plan.
Individual Health Insurance Continued
How to Decide Which Option is Best for You? We’re Here to Help.
Tips for receiving “advanced premium tax credits” through CoverME.gov:
- You must provide every household member’s social security number.
- The premium tax credit is based on this year’s projected modified adjusted gross income. Many people struggle with this. Click here to learn more about what counts as taxable income.
Click here to learn more about what counts as taxable income.
- Key thing to be aware of: You can go in and adjust your income during the year if your situation changes. For example, you receive an inheritance, and your income increases significantly. In this case, adjusting your income sooner rather than later is better. Come tax filing time the next year. You will be paying back premium tax credits because you earned more than you said you would earn.
- It is better to overstate your income than understate it. Either way – if you over-state, you will get money back; if you understate, you will have to pay back.
- CoverME will ask you to verify your income. This requires you to update proof that you will earn what you have stated on your application. Don’t ignore these notices. They will take away your premium tax credit if you don’t do it.
Getting Started with CoverME.gov.
Set Up Your Account!
***** VERY IMPORTANT*****
When setting up your CoverME.gov account, the younger of the two spouses must be listed as the primary on the account!
Once your account is set up, We are happy to help you select from the many health insurance plans. A list of your doctors and medications is very important in choosing a plan.
Also—Important Things to Consider:
- Historically, have you been a high, medium, or low user of health insurance?
- Is there a family history of dread diseases, such as cancer, that you are concerned about?
- How many times per year do you visit your PCP?
- How many times per year do you visit a specialist?
- Do you spend a lot of time out of the state of Maine?
- Do you have children attending college outside of New England?
- Is having access to Boston hospitals/providers important to you?
- When choosing a plan, it is critical to ensure your doctors are in-network and your medications are in formulary.
