Getting Health Insurance after Open Enrollment Period

health insuranceIf you were planning on using the federal exchanges (or your state’s equivalent) to get health insurance coverage, it’s now too late to get in under the open enrollment period.

That deadline came and went at the end of March, though the federal government extended the deadline a couple of weeks for those who started applications on time but ran into a snag.

Everyone else was either supposed to get qualifying coverage or face a fine of either $95 dollars or 1 percent of income, whichever is greater (for 2014. Penalties increase in future years).

For whatever reason, if you missed the deadline, or if you lost coverage, here are your options, post March 31:

1. Buy a policy in the open market. Obamacare isn’t the only game in town. For now, anyway. Policies in the open market can be more flexible and more robust than those on the exchanges, and you almost certainly have more choices.

Furthermore, you will likely find your care networks less restricted with an individually bought policy off the exchanges than you would with a typical exchange plan. This is because the plans on the exchanges are biased toward managed care plans like HMOs, which contain costs by limiting available care providers covered under the plans.

The downside is that you must go through medical underwriting. Plans offered outside the exchanges after the open enrollment period may decline you, or charge a higher premium, based on your health history.

The other downside applies to those with lower incomes: These plans are not eligible for the so-called ‘Obamacare subsidies.’

2. Take advantage of a special enrollment period. You can still go through the exchanges if there has been what officials call a qualifying life event:

• Relocation to a new state;
• Substantial change in income;
• Loss of coverage under another plan (i.e., after a job change or job loss where you were covered by the old employer’s group plan);
• Birth or adoption of a child;
• Divorce (resulting in loss of coverage);
• Marriage.

You can also qualify for subsidies if you enroll in a qualifying plan via the exchanges, and you must be issued a policy regardless of your medical history or condition.

3. Apply for Medicaid / CHIP. Medicaid is a federally subsidized, state-administered program to provide health insurance to the needy and indigent. Some states have expanded Medicaid enrollment with federal dollars provided (for a limited time) by the Affordable Care Act, while other states have declined to expand the program.

Specific qualification thresholds vary by state, but are generally pretty stringent for Medicaid. For example, total assets, not counting certain exclusions such as home equity, a car, workers tools, etc. (depending on the state) must not exceed a couple of thousand dollars, and monthly income must also fall below a certain amount.

You can apply for Medicaid, or for an offshoot of the program for children, CHIP (Children’s Health Insurance Program) at any time. However, under the Deficit Reduction Act of 2005, officials can ‘look back’ as long as five years in considering whether you meet the criteria to receive benefits.

For more information on qualifying for Medicaid, click here.

4. Get in under the COBRA window. If you had coverage under a COBRA plan, you now have up to July 1 to enroll in an ACA plan via an exchange. The Department of Health and Human Services just extended the deadline for those individuals and families because of confusion and unclear guidance these people received from the COBRA plans themselves.

5. Small business owners – you can apply for SHOP, year round, and get coverage for yourself as an owner employee and your employees. Restrictions apply, and you generally cannot discriminate. Your business may qualify for SHOP if you have fewer than 50 employees. Your business may receive a tax credit designed to partially offset the costs of providing group coverage to your employees.

Read more news, advice, and career tips in Vitaver’s blog

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