Confused about Your Health Coverage? Ask The Savant!

“Mr. Savant, help me!!” is something I hear almost daily. This cry comes more often when the period known as Open Enrollment begins. It may not be a coincidence it follows only weeks after Halloween with premium increases, ever growing deductibles and confusing terms like coinsurance it can be a scary time for many. What I plan to do in this column is help make health insurance less confusing for anyone that either purchases their own health coverage or would like to better understand the coverage made available for them by their employer. Let’s start with Open Enrollment itself.

What is Open Enrollment?

Open Enrollment is the time period when anyone not on a company group plan can buy health insurance. Kind of. What I mean by “kind of” is a plan can also be purchased or changed if the insured experiences a “qualifying life event.” And non-ACA plans can be purchased year-round. I told you it was “kind of.”

What is a “qualifying life event” or even an ACA plan?

Let’s take these one at a time.

Qualifying Life Event

A life qualifying event are things like loss of coverage, moving, getting married or having kids. There are a few more events  like getting citizenship or exiting prison. Any licensed health insurance agent or, of course, The Savant can help you figure out if you’ve had one. But you need to act in a timely fashion, you only have 60-days to make changes after such an event.

What is an ACA plan?

ACA – Affordable Care Act or Obamacare.

The ACA is the plan developed during Barak Obama’s presidency, hence the name, Obamacare.  The items that are the foundation of an ACA plan include “guaranteed issue.” That means anyone can purchase it regardless of health status.  It also must cover, and you must pay for, coverage of the “Ten Essential Health Services.”

  1. Outpatient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn
  5. Drug and alcohol rehabilitation and mental health services
  6. Prescription drugs
  7. Rehabilitative services
  8. Laboratory services
  9. Preventive, wellness and chronic disease services
  10. Pediatric services

I don’t find my ACA plan very “affordable.” Why?

If you don’t find it affordable, it may be you don’t qualify for and receive a subsidy. If you make over a certain income, you must pay the full price for the plan. For many, this does indeed feel like it should be called the “Unaffordable Care Act.”  

And why do I need to pay for services I don’t need like drug and alcohol rehab or maternity?

Under an ACA plan you have no options except to pay.  Why must a 50-year old woman or a 25-year old man pay for maternity care coverage. Or a person that doesn’t drink alcohol pay for alcohol rehab?  

But there are non-ACA plans that do not include coverage for certain items like drug and alcohol rehab or maternity care. These plans are less expensive or more affordable because you are not paying for coverage you do not need.


Open enrollment is right around the corner. If you have any questions about your health coverage, please reach out to me, kennethwright@thehealthinsurancesavant or 917 710 2453. You may also send any questions you’d like answered in future columns to the same email address.

Connect To Your Customers & Grow Your Business

Click Here


Please enter your comment!
Please enter your name here