If you’ve lost your health insurance, Highmark can help.

Qualifying and buying a plan through a Special Enrollment Period will provide coverage for you and your family through December 31, 2021. You have 60 days from the qualifying life event to enroll in a new plan. Keep reading to learn more or start looking for a plan now. To learn more about the recently passed American Rescue Plan click here.

Lost Health Insurance

SEPs get you coverage after you’ve lost health insurance.

You have 60 days from the date you lost your health insurance to enroll in a new health plan. If your employer has given you advanced notice that you will be losing your insurance coverage in the near future, then you can also apply up to 60 days prior to losing your coverage.

Usually you have to wait for the Open Enrollment Period to sign up for a plan. But losing your job, and therefore your employer’s health insurance, is considered a major life event.

Here’s what you’ll need to enroll in a new plan:
  • Documentation, like a letter from your employer, that your insurance coverage has ended
To see if you qualify for financial help, bring:
  • Your unemployment compensation
  • The income of every member of your household
  • Additional kinds of income like interest, alimony, child support, cash support, or capital gains

Other Qualifying Events

There are other life events that could make you eligible to enroll in an SEP, including:

  • Having a baby
  • Getting married
  • A recent move
  • Turning 26

What is ACA insurance?

The Affordable Care Act, or ACA, is the comprehensive health care reform law that aims to give individuals, families, and businesses more choices and protections in finding health insurance. These plans guarantee coverage to everyone with no exclusions for pre-existing conditions.

Every Highmark ACA plan has the following:

  1. Outpatient care
  2. Emergency services
  3. Hospitalization, surgery, and overnight stays
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services, including behavioral health
  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
Financial Assistance

80% of Highmark Individual & Family plan members qualify for financial assistance

If you’re worried about paying for your new plan, there are two ways to help make it more affordable:

  • Advanced Premium Tax Credits (APTC) – These are based on your household size and income and may lower your monthly premium.
  • Cost-Sharing Reductions (CSR) – Based on size of household and income you may qualify for lower out-of-pocket costs that you may pay when you receive care. Must enroll in a Marketplace Silver plan to utilize these.

If you have questions our Highmark Representatives are ready to help you get a free quote, find the right plan for you and your family and walk you through the enrollment process.

Understanding plans and costs

Once you know if you’re eligible for financial help, you’ll need to decide where you’re going to buy your plan. You have two options:

On the Marketplace

These are Highmark plans that are bought through the federal government marketplace. These plans offer financial help that can lower monthly premiums and out-of-pocket costs for people who qualify. 

Off the Marketplace

These plans are bought directly through Highmark and do not come with any kind of financial help. Additional plans may be available off-marketplace.

Choose your Metal Level

ACA plans are organized by metal levels. When signing up for a plan, you can choose how you want to split up your costs with your insurer. The quality of care is the same for every level.

  • Gold – Higher monthly premiums, lower out of pocket cost.
  • Silver – Moderate premiums and out of pocket cost. You must select this metal to be eligible for CSR.
  • Bronze – Lower monthly premiums, higher out of pocket cost.
  • Catastrophic – Only for people under 30 or for people undergoing certain hardships. Protects people from the large health bills that come with catastrophes.
Understanding Plans and Costs

Coverage Options

Other coverage options

If an Individual or Family plan doesn’t seem like the right fit for you, there are other options that could help.

Conversion plans

If you enroll in an Individual or Family plan through an SEP, you may experiencea gap in coverage. Conversion plans are here to help people who need coverage that begins mid-month or retroactive health coverage.

Children’s Health Insurance Program (CHIP)

CHIP provides comprehensive health insurance coverage for children under the age of 19 – regardless of household income.

Medicaid

Medicaid is a federal and state program that helps cover medical costs for people with limited income and resources.

Consolidation Omnibus Budget Reconciliation Act (COBRA)

COBRA is a health insurance program that allows individuals and families to continue receiving health insurance benefits after the loss of employer-based insurance coverage. Speak to your employer’s benefit manager to learn more.

We’re here to help you every step of the way.

Our Highmark representatives are ready to help you find the right plan for you and your family and walk you through the enrollment process.

Talk to a Highmark representative to discuss all your options. Call: (877) 720-6352.

Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.