With Obamacare open enrollment (the official name of the program is the Affordable Care Act) closed for 2014 enrollments who is able to get new coverage and how? This is a question plaguing many who didn’t sign up on time. In some cases these individuals will be able to gain coverage still, in other cases it’s going to be a long wait until January 1st 2015 the earliest their new coverage can kick in.
Those who incur specific life events, which for those on group coverage thru employer are the same that allow changing around the group plan, are required to get a special election period as they are called. For those not used to what Life Events are, let’s go thru some of them to put it in perspective. All life events involve fairly major life events that change the course of life for those affected. It’s not a snap decision to just go get insurance because one became sick.
The government gives a vague definition of qualifying life events including examples. The general idea though are that issues such as gaining or losing a job, getting marries, divorced, loss of a spouse, birth of a child, or death of a child will lead to a qualifying event. Other circumstances such as moving out of your current plan service area will generally create a special election period as well. For instance moving from Houston to Austin where the plans are different and some of the Houston carriers don’t offer plans and other plans offer options not sold in Houston, a plan change may be approved. These special election periods will allow for a new plan or change of plan to occur (or even cancellation where you are gaining other coverage thru a new job or marriage) within a set time frame around the event. Failure to exercise the election timely will result in it being lost.
Since enrolling in health plans is now heavily regulated and limited in terms of when one can sign up and when the new plan will become effective, it’s typically wise to enroll immediately upon learning a special election period is available. Enrollments effective dates are 1st of the next month when the application is completed by the 15th of the current month. Applications completed between the 16th and end of the month are effective the 1st of the second following month. (An application on 17 June will be effective on 1 August, where an application on 15 July will also be effective on 1 August.)
Insurance carriers will seek some documentation as proof of being eligible to take a special election period. Depending on the reason provided for the special election period it may be easy or not to prove the special election period. Death or birth is fairly simple, and honestly birth is a function of adding the baby to the parents existing plan. Thus, before applying gather up some evidence so it’s ready to submit when requested as part of the application process.
One option for those who can’t get full individual health coverage is to consider a temporary health plan. A good agent can help you pick one that is right for you. It’s one option to limit exposure to accidents or illnesses that arise between the time the policy is approved and its endpoint days to a year away.
One key point to remember, for those who don’t have a specific life event signing up outside the annual enrollment period is not an option. Thus, if it was missed this year be sure at the end of the year to get signed up so coverage is in place for future years. Waiting until one gets sick and expecting to sign up for coverage and shift the cost to the insurer is not possible without creating a life event. Thus, for that reason and the penalties for not having coverage, signing up during the annual enrollment period is a good idea.
There are many considerations you should make before pulling the trigger and making a change. For help with life insurance in Texas be sure to give us a call. We are here to help with new policies or even help you replace coverage or sell your policy to a buyer. We can also help you with Long Term Care Insurance, Health Insurance, and Disability Insurance.