Sandpiper Insurance

Unhappy About Health Insurance?

Open enrollment for health insurance plans complaint with the ACA (Affordable Care Act) often know as Obama Care has ended. Changes are only available to individuals and families that experience a qualifying life event (QLE) such as loss of employer coverage or moving out of the service area of your current plan. For a complete list of QLEs visit

Because of the mandates that individual plans must include the 10 essential health benefits (EHBs) premiums had to increase. Not everyone needs all the mandated coverages, but policy premiums reflect their inclusion. There are no options to delete or eliminate any of those provisions. ACA plans are most suitable for individuals with pre-existing conditions or have lower family income and are eligible for advanced premium tax credit (APTC).

With the elimination of the financial penalty for not having ACA compliant coverage other options have entered the arena. Healthy individuals can apply for non-compliant plans. These plans require a brief health questionnaire and are not guaranteed issue. As a result, less healthy individuals are not accepted. Therefore, the members are generally healthier than the overall population allowing the carriers to charge lower premiums. Premium savings can be realized at all ages, but the most significant reductions are individuals in their 60s not yet eligible for Medicare. These plans are not on the ACA platform so enrollment can occur year-round. Savings can be significant and plan design is flexible, so they allow for numerous variations on each policy series.

It is likely at this point that you have more questions than answers. I can be contacted at no cost or obligation to address those unresolved issues.

John Croes
President, Sandpiper Insurance Company


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