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INDIVIDUAL & FAMILY

Health Insurance FAQs

We strongly encourage you to learn about health insurance as much as possible before choosing a new health insurance plan.

Insurance Subsidies

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How do I qualify for Premium Tax Credit and Cost-Sharing Reduction Subsidy?

There are a few requirements you have to meet to be eligible for the subsidy. Learn more here: Health Insurance Subsidies.

What factors are taken into consideration in calculating the subsidy amount?

The amount of the subsidy depends on the number of people in the given household, as well as their age, place of residence, and income.

In what type of an insurance plan can I use the subsidy?

Premium Subsidy, aka Premium Tax Credit can be applied to one of the four metal plans. However, Cost Sharing Reduction Subsidy (CSR) can be applied only to the Silver Plan. Which option will work best for you, will depend on your income, as well as your eligibility for CSR.

How will I receive the premium subsidy?

The subsidy may be received in 2 methods:

  1. Direct payment to the insurance company – the government pays the subsidy directly to the insurance company. You will only pay your portion of the insurance premium.
  2. Tax refund – if you don’t use the first method, then eventually you may receive the subsidy if you qualify when you file your taxes for a given year.

Please read the next question to learn how income calculated during tax return filing may have an effect on your subsidy.

Can the amount of Premium Subsidy change?

In the application for new insurance with a subsidy, you are asked to declare an estimate of your income for next year (for example for the year 2017). A lot of people, especially self-employed individuals, are not able to accurately estimate their income. That is why, the income you declare on your application will be compared to the actual income at the time you file your taxes for a given year.

In instances where the declared income will be less than the actual income, the Internal Revenue Service will pay out the balance due of the subsidy. In instances where the declared income will be more than the actual income, then the taxpayer will have to return the overpayment of the received subsidy.

EXAMPLE:

A family declared $40,000.00 of combined income for the year 2018, and received a subsidy for that year in the amount of $8,500.00. In March of 2019, in their tax filing, the family declared their actual combined income for the year 2017 as $35,000.00. Since the family’s actual combined income was less than the declared income indicated in their application, the family will receive the outstanding balance of their subsidy in the form of a tax credit. If in fact the family’s actual combined income was $50,000.00, then the family would have to pay back the portion of the subsidy that was overpaid.

If I don’t qualify for the Subsidy, can I still purchase health insurance?

Yes. For more information, please call us at (773) 789-7233 or our toll free number 1-800-SAFEPOL (1-800-723-3765).

What type of income is taken into consideration when calculating the Subsidy amount?

In calculating the subsidy amount, the household income is taken into consideration, of all family members filing their taxes on the same tax return. The following income types are considered:

  • Net Income for self-employed individuals,
  • Employment income (salary, wages, as reflected on Form W-2),
  • Tips,
  • Unemployment,
  • Social Security Income.

Other types of income, which also must be included, are rental income, bank interest, dividends, child support, spousal support/alimony, and income from outside of the United State

Enrollment Periods

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What is the Open Enrollment Period?

It is a time period every year when you can buy a health insurance plan for the next year. For example, in 2019 during Open Enrollment people will enroll in health plans for 2020. 

When will be the next Open Enrollment?

It will be between 11/01/2019 and 12/15/2019. During the time you can buy or change health insurance for 2020.

What is Special Enrollment Period?

During Special Enrollment Period you can also enroll in a health plan but you have to have a qualifying life event. In this sense It is different from OEP.

Health Insurance Plans

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What do new health insurance plans cover?

New health insurance plans cover the 10 Basic Essential Health Benefits, which in many cases were not covered in the old system.

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care
Can a new insurance plan be denied due to health issues?

Yes and no. No, if you buy health insurance during Enrollment Periods, yes, outside them. If health insurance is purchased during Open Enrollment Period or during Special Enrollment Period, insurance companies will not be able to deny insurance coverage due to pre-existing conditions.

The Special Enrollment Period allows you to purchase health insurance outside the Open Enrollment Period in limited situations such as:

  • Losing health insurance coverage at work,
  • Change in your income,
  • Moving to another State, or
  • Change in the number of household members (marriage, divorce, new baby, death).

Failure to obtain insurance during the Open Enrollment Period or not qualifying for the Special Enrollment Period, may have significant financial ramifications on you, if you start having health problems. In this situation, in order to obtain insurance, you will have to wait until the next Open Enrollment Period. Please note, that coverage purchased during the Open Enrollment Period won’t be effective until January 1 of the upcoming yea

What information is necessary in order to obtain subsidized health insurance?

Before you start the application process, you should have the following information ready

  • Social Security Number of all household members,
  • If you are not a United States citizen, you need Green Card or other valid visa number,
  • Calculation of the household income,
  • Employers information such as: business name, address, and phone number.
How does health insurance work? What is the difference between deductible and co-insurance?

Immigration Status

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Do individuals without legal immigration status in the United States qualify for the subsidized insurance?

Individuals who do not possess legal immigration status do not qualify for subsidized coverage. In order to obtain information about your health insurance options without premium credit, please call us at (773) 789-7233 or our toll free number 1-800-SAFEPOL (1-800-723-3765).

Do Green Card or other valid visa holders qualify for premium subsidy?

Yes. Individuals who possess alien registration cards and certain valid visa holders such as student visa, work visas, will qualify for the subsidy, providing they meet all other eligibility criteria.

Other Questions

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Is SafePol an insurance company or an insurance agency?

SafePol is an insurance agency representing various health and life insurance companies, such as: Blue Cross  Blue Shield, Humana, Aetna, Metlife, Prudential, ING or Transamerica.  Further, due to the change of the health insurance law, we also help to apply for subsidized health plans. Read more in About us.