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  3. Understanding Health Insurance

Understanding Health Insurance

You have to start somewhere. Let's break down the essentials of getting yourself insured.

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PLANS 101
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What is the Affordable Care Act?

The Affordable Care Act (ACA) — sometimes called Obamacare — is the health care reform law that makes health plans available to people who are looking to buy their own health plan.

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Coverage options when you’re uninsured

If you don’t have, or lose, coverage through your employer, you have a few different options for staying insured.

  • Illustration of a medical red cross symbol hovering over an outstretched hand- Highmark ACA plans

    ACA

    Quality, affordable individual and family plans that cover preexisting conditions, the 10 Essential Health Benefits, and more.
  • Calendar illustration with a date circled showing the limited time to get COBRA Highmark insurance after losing a job

    COBRA

    If you have previously had coverage through an employer, COBRA is a federal program that allows you to extend your employer benefits for a limited time after you lose your coverage.

Frequently asked questions

  • Any U.S. citizen, U.S. national, or otherwise lawfully present in the U.S.*
  • You must live or reside in our Service area.
  • Individuals not currently incarcerated.
  • Individuals not enrolled in a Medicare plan.

 

* Only a requirement for purchasing plans on the marketplace. There is no citizenship requirement for purchasing plans directly though Highmark or other health insurance companies.

  • If you experience a major life event, you may qualify for a Special Enrollment Period to sign up for an individual or family plan
  • Examples of qualifying life events: loss of employer-based coverage, birth of a child, move to a new ZIP code
  • A Special Enrollment Period is your only opportunity to enroll in an individual or family plan outside of the annual Open Enrollment Period

You can purchase individual or family ACA plans via:

  • Online marketplaces, also known as federal or state government exchanges. If you’re eligible for financial help, these plans can help lower your monthly premiums and out-of-pocket costs.
  • Direct from Highmark Blue Shield of Northeastern New York (Highmark BSNENY). These plans don’t offer financial help, but you will find some additional plan options here.
  • The annual Open Enrollment Period starts on November 1 in PA, DE, and WV and November 16 in NY. The end date varies by state.
    • PA, DE, and WV: January 15
    • NY: January 31
  • For coverage that begins on January 1, regardless of state, enroll by December 15.
  • Special Enrollment Periods last for 60 days from the qualifying life event.
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Let us help

Highmark Blue Shield representatives are ready to assist you, Monday – Friday, 9 a.m. – 7 p.m., and Saturday, 9 a.m. – 2 p.m.

CALL (800) 700-8482

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