Health and Dental Insurance

This section of the website contains information on the following:

Affordable Care Act (AKA “Obamacare”)

: These plans apply to individuals under age 65. As an exception, individuals over 65 who are not enrolled in Medicare Parts A and B can also apply for these plans.

These plans are sold on what is called the “marketplace” or “exchange,” which is the only place where individuals who qualify for tax subsidies (called “advance premium tax credits”) can purchase insurance. As of January 1, 2025, except for twenty jurisdictions (CA, CO, CT, DC, GA, ID, KY, MA, MD, ME, MN, NJ, NM, NV, NY, PA, RI, VA, VT, and WA) these plans are purchased through www.healthcare.gov. Georgia is establishing a new state-based exchange effective January 1, 2025. Florida participates on healthcare.gov. See https://www.healthcare.gov/marketplace-in-your-state/ for more information.

Individuals who do not qualify for subsidies can buy EITHER on the marketplace or directly from insurance carriers. Buying directly from an insurance carrier is referred as to buying “off the exchange.” Note that any plan that complies with the Affordable Care Act (either on or off the marketplace) must comply with the law and must include what are called the ten “Essential Health Benefits.”

The Open Enrollment Period for 2024 plans ran between November 1, 2023 and January 16, 2024 on the Federal Facilitated Marketplace (healthcare.gov). Open enrollment is the ONLY time individuals can buy an Affordable Care Act plan without having what is called a “qualifying life event” (examples are moving to a different plan service area, getting married or divorced, birth of a child, losing Medicaid eligibility, etc.)

NOTE: Dates for open enrollment for plans bought through State exchanges not participating on healthcare.gov differ slightly in some jurisdictions. However, as a minimum, open enrollment dates on State exchanges must include the dates for Open Enrollment on healthcare.gov. Also, insurance carriers who offer coverage directly (“off-marketplace” plans) generally follow the same dates for open enrollment as for on-exchange plans for their jurisdictions, but these dates CAN differ from the on-exchange dates.

Unless a person has a qualifying life event outside of open enrollment, the only types of plans he or she can purchase outside of open enrollment are short-term health insurance, health (hospital-surgical) defined benefit indemnity plans, group plans available to individuals and families, supplemental health plans, or dental, vision, and/or hearing plans as described below.

Until January 1, 2019 there was a federal tax penalty for individuals who did not purchase an Affordable Care Act plan or who qualified for another type of plan (such as Medicaid or healthcare/medical cost sharing) that was either recognized as meeting Affordable Care Act requirements or was exempted under the Act. CA, DC, MA, NJ, and RI have state tax penalties for individuals who do not enroll in plans that meet ACA requirements. VT statute requires state residents to enroll in Affordable Care Act-compliant plans, but there is presently no penalty for non-compliance.

Short-Term Health Insurance

: These plans do not comply with the Affordable Care Act and, effective September 1, 2024, duration of these plans must be limited to three months and the maximum coverage period can be no more than four months, including renewals or extensions. Plans purchased before the effective date are grandfathered. Florida permits these plans to be bought to the maximum duration permitted, but states are permitted to mandate shorter durations, make these plans available only at certain times of the year, or, like California, not offer these plans at all.

Health (Hospital-Surgical) Defined Benefit Indemnity Plans

: In today's market where health insurance is often unavailable or not affordable, a Health (Hospital-Surgical) Defined Benefit Indemnity plan can help families budget and pay for health care expenditures. By providing a choice between different levels of hospital, medical and outpatient coverage, individuals and families can choose a plan according to their health care needs.

Note: these are not major medical plans and are legally referred to as Limited Benefit plans. They do not comply with the Affordable Care Act (for example they do not include all the minimum essential benefits) and until January 1, 2019 were subject to tax penalties until these were eliminated January 1, 2019.

Eligibility for these plans is based on medical underwriting and not all those who apply will be eligible for coverage. The plans have a 12-month pre-existing condition limitation, and pre-existing conditions are not covered until the policy has been in effect for 12 consecutive months.

Group Plans Available To Individuals And Families

: Some Group insurance plans are available to self-employed individuals or members of certain Associations. These plans permit enrollment on a year-round basis and require successfully answering health questions to qualify. The plans utilize either large Cigna or Blue Cross/Blue Shield national PPO networks. These plans provide for continuous enrollment (i.e., annual re-enrollment is not required), and members can remain enrolled until age 65 if they have an America’s Choice national Blue Cross/Blue Shield PPO plan or with no age limit if they have one of the Association plans that use the Cigna network. Since short-term plans with durations beyond four months are no longer an option for anyone after September 1, 2024, these plans are a very attractive option for those who might otherwise have selected a short-term policy when longer duration short-term policies were available. None of these plans are available in Washington state, and the America’s Choice national Blue Cross/Blue Shield plans are otherwise not available in CA, NH, OR, VT, or VA.

Supplemental Plans

:  These plans do not include all the ten Essential Health Benefits and do not otherwise comply with the Affordable Care Act. They include supplemental benefit plans like critical illness, cancer, accident, and hospital indemnity plans. These plans can be bought up to age 65 in almost every state and some can be bought after age 65 depending on the carrier and the state. Most of these types of plans require answering health questions to qualify.

Dental, Vision, and Hearing Plans

: Dental, vision, and/or hearing plans can be bought on either an insured basis or as discount plans. They can be purchased any time during the year, and in most cases are available to persons of all ages.