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Shop Smart When Considering Options for Health Insurance

What to know regarding short-term or limited benefit plans

By the Office of Superintendent of Health Insurance

Santa Fe, NM – With the health insurance open enrollment period nearing its December 15th deadline to enroll in a plan, many New Mexicans are shopping for health plan options, and budget is often a top consideration. The Office of Superintendent of Insurance (OSI) encourages consumers to shop smart by reviewing healthcare needs, budget (including monthly premiums and estimated out-of-pocket costs such as deductibles and copays), and carefully weighing all of their options, especially when reviewing short-term or limited-benefit plan options. These types of plans may not provide the required ACA essential health benefits which may lead to a surprise fee assessed through their federal income taxes for consumers who use this type of plan as their only health insurance coverage.

Many short-term or limited-benefit plans may not be subject to certain ACA rules such as provided at least the 10 areas of essential health benefits including coverage for emergency services, hospitalization, prescriptions, lab test, preventive care services and chronic disease management, pediatric services, ambulatory services, maternity and newborn care, mental health and substance use disorder services, and rehabilitative and habilitative services. Additionally, these types of plans may apply maximum dollar amounts on benefits, may deny eligibility for coverage, or may even exclude or deny coverage for services due to pre-existing conditions.

A new, free tool provided by OSI helps consumers look at options for plans On- and Off-Exchange in a simple, easy-to-use format that provides essential health benefits, with many options for $0 monthly premiums or low-cost premiums if the consumer qualifies for financial assistance. The tool located at www.OSICompareHealthPlans.org, “Understanding your options including the total out-of-pocket impact each type of plan provides is key when considering a health insurance plan,” said Superintendent John G. Franchini. “We have heard that consumers may consider limited-benefit plans due to cost, but this year there are so many affordable plans for individuals and families who qualify for financial assistance, I encourage consumers to carefully consider all of your options by using our new tool before selecting a plan.”

Tips to remember:

  • Open Enrollment ends December 15th for the marketplace, ACA-compliant plans, anyone contacting you after this deadline is not selling an ACA-compliant plan. · Use the free online tool at www.OSICompareHealthPlans.org to view all of your qualified health plan options.
  • Be wary of telemarketers from “national enrollment centers” as the federal government will never contact you to sell you health insurance, and never provide your Social Security number, banking information, or health information to a cold-caller. · You can find authorized in-person or phone assistance at www.beWellnm.com

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