Every year on December 14th, the local television stations run pieces on their newscasts reminding Texans that tomorrow is the last day to enroll in individual health care plans. If you watch the six o'clock news or get fed their social media feed, you've certainly seen these stories. The phenomenon known as Open Enrollment on the health insurance marketplace is a result of the Affordable Care Act, aka Obamacare, which was signed back in 2010. This landmark legislation, no matter how you view, changed the way that Texans purchase their individual health coverage if they are under the age of 65.
When these news stories run, it alerts people that they need to take action which sets a chain of events into motion. Great Texans like Silvia call into our offices on that last day trying to get something done in a panic to secure healthcare coverage for the upcoming year. Given how slammed the health agents are on this last day, we always get the question asked of "can I sign up for health insurance after open enrollment"?
Since individual health plans can be thoroughly confusing, we always try to make sure that people understand their health insurance options available to them no matter the time of year. But the last two weeks of December can prove to be tricky because not every Texans understands the rules of enrollment. So we want to spell out exactly what Silvia had available to her since you are likely just like her.
Yes, You Can Sign Up For Health Insurance Outside Of Open Enrollment
While Open Enrollment still exists for the health insurance marketplace plans and technically closes on December 15th each year, you need to understand that Texans can still get health benefits past that date. How you make those changes to your family health insurance will depend upon your circumstances. Let's take a look at what your coverage options are depending upon the period of time throughout the year.
ACA Exchange
For Texans who do not have access to an employer based health plan, many of them turn to ACA-Compliant Plans for various reasons. For many, it is simply because of the guaranteed coverage for pre-existing conditions. If you fall into that category, you have to be aware of enrollment deadlines like the December 15th deadline that may have just passed you by.
The good news is that there are multiple ways to secure health insurance coverage outside of the open enrollment period. The first is a special enrollment period that runs from December 16th to January 15th. That's right, you can still enroll for ACA-Compliant Individual Market Plans until January 15th of the next year and still have eligibility for marketplace subsidies assuming that your household income allows you to qualify. This is a satisfying revelation to many Texans as they ponder their options. You can have your monthly premiums reduced by those subsidies and also obtain access to cost free preventive care. And while the policy won't be active until February 1st, you will have comprehensive health insurance that has the essential coverage that many Texans crave.
If you find yourself outside of the regular open enrollment and the special open enrollment that runs until mid January, you can still get marketplace coverage. There is a continual special enrollment period that opens up when Texans experience a qualifying life event. A Qualifying Life Event is a major change in your situation that qualifies you to enroll in an health insurance exchange policy outside of the time period. These events will be categorized into four main buckets and only apply to policies sold on the exchange.
- Loss of Health Insurance Coverage - could be due to job change, COBRA loss, eligibility changes in Medicare/Medicaid/CHIP, or turning 26.
- Changes In Household - Marriage/Divorce, having a child/adoption, or a death in the family.
- Change in Residence - if you move to a different state, change college, or other changes such as migrant workers or moving from a shelter.
- Other Events - becoming a citizen, income changes, leaving jail just to name a few.
While you will likely need documentation to prove that a special enrollment period is warranted, the process to obtain these healthcare plans is fairly simple. It is a process that the agents at Insurance For Texans help with regularly. But what if these circumstances don't apply to you or you are seeking a different option? The good news is we work with other alternatives as well!
Short-Term Health Insurance
Short Term Medical plans were originally put in place when the exchange health insurance plans were rolled out in 2014. They were designed to cover short-term coverage gaps between health insurance coverage ending and open enrollment starting and a special enrollment period not being available. These plans have morphed over time, and can now be used as a longer term solution with some stipulations.
- These plans are not required to provide essential coverage as mandated by the Affordable Care Act.
- Thees plans are considered non-aca compliant coverage and therefore play by their own rules.
- These plans are underwritten and can therefore exclude pre-existing conditions.
- These health insurance policies can last no more than 364 days and then must be re-written.
- The initial policy and subsequent re-writes can total three years.
- Even if you are a pregnant woman, these policies may not have maternity benefits, covered wellness visits, or other preventive measures like vaccines.
- Prescription Benefits will vary greatly by company.
- These plans have VERY flexible deductibles and maximum out of pocket costs. This makes them appealing to a wide variety of people.
- Some can include traditional copays for Primary Care visits.
- These health insurance policies are in fact insurance, unlike healthcare sharing plans. That makes your ability to manage costs via a PPO network easier.
When you understand both the positives and negatives of short-term health plans, they become a valuable tool to help Texans obtain options for coverage. However, short-term health insurance coverage can have gaps in coverage for people who are not paying attention or are misled by uneducated health insurance agents. It is incredibly important to understand what you are receiving in these short-term plans.
Catastrophic Health Insurance
While some folks will consider limited benefit plans like indemnity plans as an option, we do not believe that these are appropriate for stand-alone coverage. However, when an indemnity plan is used as part of a package they can become very useful. One way that private plans like these can be used is as a Catastrophic Health Insurance plan.
If you are old enough, you may remember a time when you used to pay for your primary care out of your own pocket. You carried insurance to cover the big items like hospitalization, surgeries, and critical illnesses rather than involving insurance companies in the day to day of care provided by your family doctor. For many of us, this was an easy solution that allowed for us to have a relationship with our doctor who could remember our medical history and not have the federal government involved in our decisions.
As health reform has occurred over the last few years, we have seen a resurgence of doctor harkening back to this model of care by opening cash pay practices or creating a membership based Direct Primary Care practice. The downside is that most major medical plans want to be involved in everything! The good news is that there is a way to cover you from a purely catastrophic basis with some strategic and affordable health plans. But like everything in life, there are tradeoffs. So you must understand the difference in coverage between health plans and here are reminders with Catastrophic Health Plans.
- Catastrophic health plans are not just sold through marketplace coverage in spite of what you may read.
- These catastrophic plans are usually underwritten and can therefore exclude pre-existing conditions.
- These health insurance policies do not have time restrictions like the Short Term Medical policies.
- These health insurance policies do not meet Affordable Care Act guidelines for covering the Minimum Essential Components.
- Since Primary Care is not covered by the policy, covered wellness visits or other preventive measures like vaccines will not be included.
- Prescription Benefits will vary greatly by company.
- These plans have VERY flexible deductibles and maximum out of pocket costs. This makes them appealing to a wide variety of people.
- Since your Primary Care visits are not covered by the plan, it pairs well with a scenario like Direct Primary Care.
- These health insurance policies are in fact insurance, unlike sharing ministry plans. That makes your ability to manage costs easier.
How Can I Get Covered Today?
If you are like Silvia and find yourself seeking individual health insurance on the open market, it's important to understand what all of your options are for you and your family. Working with an experienced independent health agent is important so that the right types of coverage can be evaluated to make sure that your medical coverage doesn't leave you high and dry when you go to use it. While enrollment dates can be important, help can be found year round.
Insurance For Texans works with many insurance companies to make sure you get the coverage you need in the most effective way for you. We work for you and not some big insurance company!
Click the button below to start a conversation about how we can help you get the right coverage today!
