2025 Personal and Small Business Health Coverage

Meet the Insurance Lady, Angela Lundy, your NO-COST Health Insurance Advocate

Now that open enrollment season is over, it doesn’t mean that you can’t sign up for insurance now. You can enroll in coverage if you have a change in family status that will trigger a Special Enrollment Period or SEP.

What is a Special Enrollment Period?

Special Enrollment Periods (SEPs) allow individuals to enroll in or change Marketplace health insurance plans outside of the annual Open Enrollment Period. Here are the main situations that qualify for SEPs:

1. Loss of health coverage:

You may qualify if you or anyone in your household lost qualifying health coverage in the past 60 days.

2. Changes in household:

• Marriage: Coverage can start the first day of the next month if you pick a plan by the last day of the month.
• Birth, adoption, or foster care placement of a child: Coverage can start the day of the event, even if you enroll up to 60 days afterward.
• Divorce or legal separation resulting in loss of health insurance.
• Death of someone on your Marketplace plan, causing you to lose coverage.

3. Changes in residence:

• Moving to a new ZIP code or county

4. Loss of Medicaid or CHIP coverage.

5. Income changes: You may qualify based on your estimated household income.

6. Other qualifying events:

• Becoming a U.S. citizen
• Leaving incarceration

For most SEPs, you have 60 days before or after the qualifying event to enroll in a plan.

Need Help With Small Business Health Insurance?

If you are a small business owner that is considering adding health benefits for your employees, having an agent that you trust is invaluable.

Lundy can help you find carriers and plans that offer the most benefits at an affordable price through: Carrier options, plan designs, rate comparison and non-medical addons like dental, vision or Telehealth.

Lundy can also help with annual renewals, including plan designs that change and rate increases. Plan designs that can change year after year. Rates change every year at renewal. Physicians can switch from being in network to out of network. And it is always important to compare different plan options and different carriers to help find the perfect fit for yourself and your employees.

There are benefits of offering Health Insurance to your employees. It will help decrease absenteeism. If your employees have insurance, they are more likely to use it, decreasing the amount of time that they are out sick. It improves employee loyalty. It shows employees that they are valued. And it can help decrease employee turnover. Employees will compare health benefit offerings before changing jobs.

Another thing to consider as an employer is the Insure OK program. This program offers premium assistance for low-income working adults. For example, a family of four with an income of $70,824 or less would qualify for assistance.

Participating in Insure OK is easy. Your employee must be between ages of 19 – 64. They must be a resident of Oklahoma. They must meet citizenship guidelines, and they cannot be enrolled in Medicaid or Medicare.

Employers will pay 25% of the premiums, the Employees will pay 15% of the premiums and the Insure OK program will pay 60% of the premiums. It is available to employers with up to 250 employees and not all employees have to qualify for the subsidy.

What are the Benefits of using the Insurance Lady?

• Angela’s assistance helps you sort through the many changes and tweaks to your existing plan and suggest options to quickly find the plan that is just right for you. • Find plans that include your doctors and your hospital preferences.
• When issues arise, she advocates for your behalf with the Marketplace and carriers instead of you sitting on hold for an extended period of time.
• Find dental and vision plans that include your preferred dentist and optometrist.

“It’s important to update your information annually, especially if you’ve had a change in your income and family status to avoid any costly repayments. If there is a discrepancy with your reported income, you might need to repay a portion of your subsidy at tax time. I can help you every quarter to make changes to your income so that it is accurate and there are no surprises at tax time,” Angela explained.

She also said that Marketplace coverage is a great option for entrepreneurs with no employees and subsidies are available for Modified Adjusted Gross Income up to 400% of the poverty level. Furthermore, Marketplace coverages are not the same as SoonerCare or Medicaid. Coverage is through carries such as Blue Cross & Blue Shield, Community Care, United HealthCare and many others.

Angla Lundy of Creative Insurance Solutions, LLC will be your NO-COST health coverage assistance and help you every step of the way with your questions, choices, and service throughout the year.