Category Archives: Special Enrollment Period

Policy Cancelled? Get Enrolled and You Can Have Insurance Coverage January 1

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As health insurance cancellation letters arrive in mailboxes across the country, anecdotes are circulating about people who are seriously ill and fear they will not have insurance to pay for their medical care after December 31, 2013. Beneficiaries in states whose health insurance marketplaces have been established by the federal government are particularly concerned because the sales website has not worked properly. However, alternative ways exist to enroll in a new health plan and coverage is guaranteed, as long as the policy is purchased within an Open Enrollment period and the premium is paid on time.

Paper Application

Paper applications have been developed for consumers to use for purchasing health insurance through any of the state or federal marketplaces. Download and fill out the application. Send it to the address listed on the application. You will be contacted with information and instructions on how to complete your enrollment in an insurance plan, including what plans are available to you, what they cover, how much tax credit subsidy might be available to help pay for the insurance, and what your cost will be.

Get a paper application right away if you plan to use this method to apply. It will take around two weeks longer than applying on-line. If you absolutely must have insurance in place by January 1, 2014, now is the time to start the process.

Work with an Agent, an Enrollment Counselor, or a Navigator

Certified insurance agents and enrollment counselors/navigators are trained and ready to help consumers get enrolled in health insurance plans.

Certified insurance agents bring specialized training and experience to the table to assist their clients in selecting the plan that will best serve their needs. Since each insurer that offers plans on the individual and family market must offer identical plans and pricing through the marketplace and outside the marketplace, agents will have up-to-date information even if the website is not working well.

Certified enrollment counselors/navigators have also been trained to assist consumers in the enrollment process. These individuals can help answer questions about the application and the process of enrolling. They do not make recommendations regarding which policy might be better suited for an individual or family’s needs. They refer consumers to Certified Insurance Agents when policy selection recommendations are needed.

Enroll On-line, With or Without Help from an Agent

Marketplace websites are improving in reliability and functionality by the day. The federal site, www.healthcare.gov, includes many tools and resources consumers can use to learn about the policies being offered in their county of residence and how much they will cost. The federal site includes links to each state site as well.

For those shopping before beginning the application process, there is a simple-to-use set of questions and drop-down boxes to develop a list of possible plans and their price. Another link takes consumers to the Kaiser Foundation’s calculator that can be used to estimate eligibility for advanced tax credit payments (subsidies) and cost sharing reductions.

Certified Insurance Agents are ready to help consumers enroll on-line. Contact information can be obtained through the marketplace websites. Designate an agent and that person will contact you to answer your questions and help you get enrolled.

It’s a New Day

Prior to the Affordable Care Act, cancellation letters would indeed have spelled disaster for their recipients. Insurers were allowed in many states to cancel coverage in case of high expenses or to set monetary limits on the benefits each beneficiary could receive for medical care. A person dropped from coverage by an insurer could not normally qualify for a policy from another insurer due to a pre-existing condition.

Today, with the coming of the Affordable Care Act (aka, Obamacare), insurance policies all include the same benefits. All legal residents of the country can shop for insurance and enroll in plans through their state or federal marketplace. Those who have been priced out of the market or excluded due to health conditions can once again have health insurance and access to care. Plans even exist that provide minimal coverage at lower prices for those who don’t qualify for subsidies but cannot afford the plans offered on the marketplaces. (These plans require a waiver before they can be purchased by anyone over age 29.)

Consumers can obtain the protection from catastrophic health care costs, paying their “fair share” of the cost of their insurance, while still being able to afford food, shelter, and the other necessities of daily life. All they need to do is enroll by December 15, 2013 and pay their premium by December 26, 2013. Their insurance will be there ready to be used on January 1, 2014.

For Help in Santa Cruz, California

For help enrolling in Santa Cruz County, please contact Kathleen Brewer de Pozos at 831-713-6438. Kathy is a Covered California Certified Insurance Agent and is happy to answer your questions and help you through the process of selecting and enrolling in a plan to meet your needs.

 Se habla Español.

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Guaranteed Issue Policies But A Limited Enrollment Period

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TermsHealth insurance policies with effective dates of January 1, 2014 or later cannot exclude people from coverage based on having a pre-existing condition. Guaranteed Issue is the term used to describe such policies. However, the fact that current or prior health history cannot be used to exclude a new customer does not mean that people can simply wait until a health condition arises and then get insurance.

Open Enrollment and SEPs

Under the terms of the Affordable Care Act (ACA), health insurance may be purchased only during specific Open Enrollment periods each year. The only exception for purchasing individual or family insurance outside of Open Enrollment is the existence of a Special Enrollment Period (SEP). A SEP occurs when certain major life conditions occur: the birth of a child, marriage, loss of employer-sponsored health insurance, ending of COBRA benefits, a move out of the plan’s service area, etc.

Getting injured or ill and suddenly needing health insurance does not constitute grounds for a SEP!

Confusion about Guaranteed Issue and Open Enrollment periods may lead some to assume that they really do not need to enroll in an insurance plan, especially since the penalty for failure to enroll is so low. Some assume that Open Enrollment period limitations apply only to policies purchased through state or federal marketplaces. These assumptions are incorrect.

Those who fail to purchase insurance during the annual Open Enrollment period will not be able to purchase a policy from any insurer unless they qualify for a SEP. Moreover, despite the low monetary cost of the penalty for failure to enroll, the actual cost can become catastrophic. Seemingly minor injuries — a broken arm or  leg — can result in thousands of dollars in hospital, doctor, and therapy charges. A major illness or injury — cancer, closed-head injury, stroke — can lead to hundreds of thousands of dollars in charges.

Insurance is a contract

An insurance policy is a contract between the person who buys it and the  insurer who offers it. The purchaser agrees to pay a set amount of money on a regular schedule and the insurer agrees to pay a set portion of the cost of a financial loss, including health care expenses.  Both parties must be legally able to enter into a contractual agreement at the time the contract is signed. An unconscious or seriously injured person cannot enter into a contract.

Protection from Adverse Selection

When the ACA was drafted, insurance companies worked with Congress to develop policies that would protect them from the devastating impact of adverse selection. Adverse selection refers to situations in which only those currently experiencing a loss purchase insurance against that loss. Insurance companies cannot provide protection only or primarily against currently occurring losses. They must have a large number of people who all put money together into one pool that can be tapped to pay for the losses experienced by a small number of them. This pool is known as a risk pool. Guaranteed issue policies greatly increase the risk of adverse selection. No insurer can reasonably consent to accepting such risk without some way to minimize it. As a result, the decision was made to control the degree of risk by limiting the time-frame during which insurance contracts can be purchased. Open Enrollment during a brief period each year was the solution, one proven effective by the history of Medicare. In recognition of the fact that things can change dramatically during the course of a year, the Special Enrollment Period option was included.

Bottom line?

Health insurance, whether through state and federal marketplaces or from private insurers, can only be purchased by individuals or families during the annual Open Enrollment Periods. This first year Open Enrollment is from October 1, 2013 to March 31, 2014.

Open Enrollment for individuals to purchase or renew policies effective January 1, 2015 will occur at the same time it does for Medicare: October 15 – December 7, 2014.

Outside of these Open Enrollment periods, it will not be possible to purchase an individual or family policy from any insurer at any price without the existence of a Special Enrollment Period’s special circumstances.

 

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