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How to Buy a Plan

 

When can you buy a health plan?

There are two enrollment periods when you can buy an individual or family health plan:

  1. Open enrollment is a fixed time period during each year when anyone can buy an individual or family health plan. It typically runs each year Nov.1 – Dec. 15.

  2. A special enrollment period allows you to buy individual coverage or make certain changes to existing coverage outside the open enrollment period. Special enrollment is specific to you and can only be triggered by what is called a qualifying life event. There are five basic types:

Involuntarily losing employment-based health coverage due to job loss or a change in eligibility for employment-based coverage. This also applies to individuals who are turning 26 and can no longer be covered under a parent’s health plan. Special enrollment will also apply to individuals who lose public insurance coverage due to changes in income or disability status.

Getting married or divorced, having a baby or adopting a child, or a death in the family.

A permanent move to a different ZIP code or county could cause you to lose access to your current individual coverage and/or gain access to other plans.

If your income changes, you could be eligible to enroll in a different type of coverage, either individual or a public insurance program like Medicaid. Income changes can also affect the amount of financial assistance you are receiving or could receive to buy an individual plan.

Less common changes that trigger special enrollment include becoming a U.S. citizen and leaving prison. Your state’s health insurance marketplace will have a complete list.

If you believe one of these situations applies to you, here’s what you need to know:

  • Your special enrollment period will be open for 60 days from the date of your qualifying event. You must buy an individual or family plan, or make a change to your existing plan, during that 60-day time period.
  • You’ll need to submit proof of the qualifying event. We can help you determine the documentation you’ll need.


Are you eligible for a tax credit?

Many people who buy individual insurance are eligible for a tax credit to help you pay premiums and out-of-pocket costs – and a lot of them don’t even know it. Don’t leave money on the table! Check to see if you qualify for financial assistance. 

There are two kinds of help.

  • Premium tax credits. You can use a tax credit to lower your monthly premium. If your estimated income falls between 100-400% of the federal poverty level for your household size, you qualify for a premium tax credit. You can use this credit to enroll in any metal level (platinum, gold, silver or bronze) plan.
  • Cost share reduction (CSR) plans. CSR plans help reduce your out-of-pocket costs by providing you with a discount that lowers your deductibles, copays and coinsurance. For the discount to apply, you must enroll in a silver metal level plan.

See if you qualify for assistance»

To receive any assistance that you may be qualified for, you must buy your plan through your State's Health Insurance Marketplace. Your estimated household income and other household information determine what you qualify for. The Marketplace can also help you apply for public insurance coverage if your income makes you eligible. 

If you are shopping for a plan in Minnesota, go to mnsure.org. For other states, go to healthcare.gov.



Where can you buy a health plan?

There are two ways to buy individual or family insurance:

  1. Through your state’s health insurance marketplace. A health insurance marketplace is a government-sponsored online store where multiple companies offer individual and family policies. Some states have their own; other states participate in the federal marketplace. 

    If you are shopping for a plan in Minnesota, go to mnsure.org. For other states, go to healthcare.gov.

    If you qualify for financial assistance, you must buy your plan through the marketplace. Your state’s marketplace can also help you apply for a public insurance program like Medicaid if your income makes you eligible.

  2. Directly from a health insurance company like Medica.


Who can help you find and buy a health plan?

There are several types of professionals who are trained and qualified to help you shop for and buy an individual or family health plan. 

Helper Type Role
Licensed Insurance Agents and Brokers
  • Educate you about health plans available through the health insurance marketplace and directly from health insurance companies
  • Help you compare plan options, check eligibility, determine your best coverage option, file an application and enroll
Navigators
  • Educate you about health plans available through the health insurance marketplace only
  • Help you compare coverage options, check eligibility, file an application and enroll

Your state’s insurance marketplace can help you find a licensed insurance agent or broker, or navigator.

If you are shopping for a plan in Minnesota, go to mnsure.org. For other states, go to healthcare.gov.

We can also help you out with any questions you have. Give us a call.

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Call Delta Dental at 1-866-764-5350 (TTY: 711).

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