Feb. 15, 2015 was the last day for open enrollment for individual health insurance. As the Southwest Airlines agent will say when giving instructions for the use of a seatbelt, “If you have been living in a cave, you might not have this information!”
Seriously, there continues to be a lot of confusion about this landmark piece of legislation, so I want to give our readers one last reminder for 2015.
The last two years has finally seen then the topic of health care insurance and financing become a major topic of discussion. In addition, the law is fluid and has been subject to many changes. The hundreds of congressional votes to repeal it are merely a political exercise. It will not be repealed under this President. The future remains to be seen. Having seen the results first hand, I suspect people will not want to give up children’s coverage to age 26, guaranteed issue coverage, no pre-existing condition limitations and many more consumer reforms.
It is critical to understand that without a mandate for coverage, the insurance companies simply will not offer “guaranteed issue” coverage. It’s quite simple. If there is no mandate or these open enrollment restrictions, most people would simply wait to apply for insurance at the hospital door.
Open enrollment periods are a foundation of delivering guaranteed issue coverage. Last year, the open enrollment period was extended multiple times. Not so this year, (so far). However, similar to last year’s end of open enrollment grace period, it will permit consumers who started an application to continue to make their plan selection for 5 days after the close of Open Enrollment. However, the applicant must use either a Covered CA certified Enrollment Representative or Certified agent to qualify for the extension.
Open enrollment means that an individual may apply for coverage during this period and the company may not reject the application. Absent a qualifying event, an individual who wants insurance after today will be told “Call me next year!”
One may apply on or off the Exchange for coverage. The primary reason to apply through the California Exchange aka Covered CA is to obtain the Advance Premium Tax Credit. (APTC). This is a subsidy provided by the Federal government to provide assistance in paying premiums. If one does not qualify for a subsidy, applying through Covered CA merely provides an additional and unnecessary layer of administration.
Most agents have a link on their websites to apply directly to a carrier, so if the office isn’t open and you want to apply today you may do so. You may also apply directly at the insurance company websites: www.anthem.com, www.blueshieldca.com, www.assurant.com. For the exchange: www.CoveredCA.com or call 800-300-1506 to apply on the Exchange. You may choose an agent on these sites. You will pay no extra premium to have the services of an agent and you will likely require service after you enroll. Click on “find help near you” to do so at Covered CA.
Special enrollment periods are tied to qualifying events and are designed to provide an opportunity for folks who have a loss of coverage or a life event to make needed changes or enroll in coverage. Following is a list of some of the events. A complete list is in the fact sheets at www.coveredca.com. Most events require that you enroll within 60 days of the event.
*Involuntary loss of group coverage or loss of Medi-Cal eligibility
*COBRA coverage is exhausted. Note once you make the election for COBRA you must either wait for it to be exhausted OR an open enrollment period
*Marriage, birth or adoption of a child, new domestic partnership
*Change of residence to another region where plans are different
*Age-off a parents plan at age 26
*Return from active duty military service
*Released from jail or prison
In most cases, if you enroll by the 15th of the month, coverage will be effective the first of the following month. Exceptions include birth of a child, in which case it is effective the date of birth.
Note that if you are eligible for Medi-Cal or are a member of a federal recognized American Indian tribe you can enroll anytime. While I am no Medi-Cal expert, I have learned that there are multiple pathways to Medi-Cal. Since this one is not asset based, only income based, it seems to make sense to enroll ASAP.
Hopefully you are reading this on Sunday before midnight. If you haven’t enrolled in a health plan, now is the time to do so. Of course the tax penalty you will pay is one motivator. The fact that a serious illness or injury can bankrupt you and cause you to lose everything for which you have worked, is likely a better one!
Margaret Beck is a Redding-based licensed insurance broker who can be reached at 530- 225-8583. All information in her column is provided to the best of her knowledge, subject to final regulation by the respective agencies.
Beck’s column is also published in the Redding Record Searchlight.