The first open enrollment season of the Affordable Care Act has come and gone and the next one doesn’t start until Nov. 15, but that doesn’t mean uninsured individuals can’t get coverage until then.
“Under the Affordable Care Act, people who experience certain life changes may be eligible to enroll in a new health plan before the next open enrollment period begins,” says Michael Mahoney, senior vice president, consumer marketing at GoHealth www.gohealthinsurance.com. “Those who qualify for a special enrollment period generally have 60 days from the qualifying event to shop for coverage. “
Here’s what health insurance experts recommend knowing about what qualifies as a “life change” to gain coverage outside of the designated open enrollment period.
What Doesn’t Work
The ACA’s open enrollment periods were designed to prevent people from only signing up for care when they need it. The limit protects health insurance companies, but it can hurt consumers if they find a better or cheaper plan outside the season.
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“Finding a new one that saves you $600 is not a qualifying reason,” says Kevin Luss, owner of Luss Group. “Even if they are going to save money, they got to stay in it or lose coverage.”
Letting an insurance policy lapse also doesn’t count as a qualifying event, he adds. Neither is a doctor dropping out of network.
People (at least two) are still able to bind together to purchase group insurance, but the ACA has made it a little restrictive. A husband and wife can’t be the only ones making up a group of two, and thus can’t get new insurance outside of open enrollment that way. The health care reform “really restricted things a little bit,” says Luss.
What Does Get an Exception
While restrictions abound, there are many qualifying events that allow consumer to pick up coverage outside of the enrollment period. Some events include, getting married or divorced, a permanent move to a new coverage area, the birth or adoption of a child, change in income or no longer being covered by a parents’ health insurance.
Experts warn being prepared to show proof of the event.
“A lot of the carriers require documentation,” says Carrie Mclean, director of customer care at eHealthInsurance www.ehealthinsurance.com. “For example, if you have a loss of employer coverage, a lot of carriers want to see a termination letter from your employer.”
Even if the carrier doesn’t require documentation, lying to get a new plan or coverage is not a good idea. According to Mcclean, if an insurer has been paying claims and asks for proof of the life event, lack of documentation allows the company to refuse to pay the medical bills.
Some of the lesser-known life events that will get you qualified include, being released from jail, gaining citizenship or becoming a member of an Indian tribe.
According to Luss, if a consumer gets bad advice from an insurance agent during open enrollment, the professional can write a letter to the provider taking the blame. “It’s really at the discretion of the carrier,” says Luss.
If all else fails, there’s always the option of taking out short-term insurance, says Mahoney.
“Short-term plans provide a viable solution if you experience a gap in coverage between now and the next open enrollment period in November,” says Mahoney. “Without insurance, a trip to the emergency room could cost thousands of dollars, but a short-term plan can significantly offset those costs.”