With the Affordable Care Act’s (ACA) March 31 deadline for 2014 health plan enrollment now having passed, many consumers are asking, “What are my health coverage options for the remainder of the year?” The answer is a bit complex, will require thoughtful consideration and most likely professional help, but there is good news.
There are options available. One of those options hinges on whether an individual has a life-changing situation, called a “qualifying event.” The other options include supplemental or short-term insurance to cover the period between now and Jan. 1, 2015. According to local agent, Callan Halsell, “A qualifying event is the best, and one of the only ways to avoid the tax penalty.”
Once a qualifying event occurs, consumers have 60 days to sign up for an ACA-compliant health insurance policy. Life events that may generally qualify consumers for a special enrollment period include: getting married, the birth or adoption of a child, divorce, permanently moving to a new area that offers different health plan options, losing other health coverage due to a job loss, a COBRA plan expiring, a health plan being decertified, an employer dropping coverage or recently becoming a citizen.
Voluntarily quitting health coverage or being terminated for not paying your premiums are not considered qualifying events. If consumers do not have a special qualifying event, then they will be unable to purchase an ACA-compliant health policy until the next open enrollment period. They will also be required to pay the penalty of $95 or 1 percent of their family income for failing to purchase qualifying coverage in 2014.
Consumers who do not have a qualifying event have the option of signing up for a supplemental or short-term health plan to bridge the gap until January 1, 2015. However, most short-term plans do not meet the ACA requirements for minimum essential coverage. In addition, short-term plans may not include coverage of certain pre-existing conditions, so the penalty will be issued.
“Supplemental and short-term policies can be attractive options, but it is important for consumers to be perfectly clear about how those options address their current medical conditions,” said Mark Bellman, president of the Texas Association of Health Underwriters.
Supplemental insurance plans include: accident policies, cancer or specified disease coverage, critical care and recovery, dental coverage, vision care, and certain types of hospitalization. For example, a cancer policy may not cover a pre-existing diagnosis of the disease, but would cover policy-specified treatments and expenses for the disease. Accident policies may pay certain cash benefits for injuries that require intensive care placement, emergency room visits, ambulance services and treatments associated with an accident.
According to Bellman, “Policies may vary by individual, geographic region and the insurance company offering the product. These are among the issues that consumers should discuss extensively with a professional when determining which coverage options best fit their needs.”
Other policies may cover some expenses surrounding critical illnesses, such as heart attacks, paralysis, blindness and organ transplants. In these cases, some policies will pay a benefit to cover certain life expenses, such as mortgage payments, utility bills and child care. Each policy will have conditions and stipulations that consumers need to thoroughly understand.
Because the open enrollment period involves a limited time span, the ability to purchase ACA-compliant coverage does not exist throughout the year. Having a limited time to enroll is a critical piece of health care reform that allows individuals with pre-existing conditions to have access to guaranteed coverage. Having an enrollment deadline requires healthy and unhealthy individuals to purchase health insurance policies, thereby eliminating the option of waiting to purchase coverage until they become ill.
“Today’s health insurance market must balance having guaranteed access to health insurance for everyone, while striving to make coverage affordable for consumers,” said Bellman.
“Missing the enrollment deadline is not an ideal position to be in, but at least there are options for bridging the coverage gap between now and the beginning of 2015. Sorting through the options can easily overwhelm a consumer not familiar with the complexities and details of health insurance policies. Benefit professionals are available at no additional cost to consumers to help them understand and weigh their options,” Bellman added.
Agent Callan Halsell says, “Seminole was no exception, to missing the deadline. Quite a few locals have been in asking about options. I think a large percent of people just didn't know about the deadline.”
The Obama Care is confusing, and even though there is plenty of information out there, it is often contradictory and hard to navigate. If you need help meeting the requirements, use one of the benefit professionals or reach out to one of the local agents, like Halsell, to help choose the best path, for your situation.