Typically, health insurance is designed for people under the age of 64.5 years old while people over the age of 64.5 would qualify for Medicare. Health Insurance is the type of insurance coverage that pays for medical, surgical, and prescription drugs that the insured (policyholder) uses during the coverage date period. Depending on the type of plan and coverage you purchase, this will entail how much of the expense will be paid for by you (insured) or the insurance company. In most cases when insurance premiums (monthly payments) are high, you pay for better coverage, meaning you will pay less Out-of-Pocket on the expenses incurred.

Each health insurance plan states what percentage of the expense will be covered by the insurer and what percentage must be paid by the insured. This is called Co-Insurance. Some plans may instead have a set dollar amount that must be paid by the insurer on the services used. This is called Co-Pay. These rates by differ based on the type of services and/or medical event inquired. Ie. Visit for primary care vs Specialist, Type of Tests/Surgery, Pregnancy, Hospital Stays, etc.

Seek plan details for further information. Some plans may also have what’s called a deductible. A deductible is the amount of money you may need to pay Out-of-Pocket before your health insurance provider pays for the rest of the bill.

Open Enrollment is a set date period when people can purchase new health insurance coverage and/or change their existing health insurance plan. The General Date period for Open Enrollment is from November 1st – December 15th. This date period can be different for some selected STATEs. During this period, everyone is eligible to purchase a new health insurance plan and/or change their current health insurance coverage.

Outside of this Open Enrollment Period is called SEP (Special Enrollment Period). During this time, you may be eligible to purchase and/or change your health insurance if you experienced what’s called a Special Event in the past 60 days. Below is a list of what’s considered to be a Special Event.

• Family Member Died
• Lost Health Insurance Coverage
• Moved to a New State
• Married/Divorce
• Lost Job/ New Job
• New Baby

If you haven’t experienced any of these Special Events during SEP, you are NOT eligible to purchase traditional health insurance during this time. However, you may be eligible to enroll for what’s called Short Term Health Insurance. Short Term Health Insurance is the type of insurance coverage that will provide the insurer with temporary medical, surgical, and/or prescription drugs. These short-term plans can be purchased from 1 – 12 months and are typically more affordable compared to traditional health insurance plans. They may sometimes also have less benefits and/or higher deductibles/co-pays/co-insurance.

Medicare is a federal government funded health insurance program setup for people who are over the age of 64.5 and also those under the age of 64.5 who have certain disabilities. People who are over 64.5 can qualify for Medicare if they have been a US citizen or permanent resident for more than 5 years AND have paid Medicare taxes for at least 10 years.

If you haven’t paid for Medicare taxes for at least 10 years, you can still qualify for Medicare, however you may have to pay a set amount for Medicare Part A.

If you are under 64.5 you may qualify for Medicare if you suffer from End-Stage Renal disease or End-Stage Kidney disease, Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease, or if you are permanently disabled and have been receiving Social Security Disability for the past two years.

Open Enrollment is a set date period when you can enroll for new Medicare coverage or change your existing Medicare plan. Medicare Open Enrollment is generally from October 15th – December 7th. Medicare Advantage Open Enrollment is from January 1st – March 31st. Outside of these enrollment periods are called SEP (Special Enrollment Periods). You may qualify to get new coverage or change your existing plan if you turn 64.5 during this time or if a special event occurs in your life.

• Moved to a New Address and no longer have the same coverage options
• Released from Jail
• Loss of Coverage
• Lost Job/ New Job
• Eligible for both Medicare and Medicaid