Open Enrollment for Obamacare health insurance lasts 45 days. If you missed your opportunity to purchase subsidized coverage, or simply forgot, there are several low-cost options that will allow you to get covered quickly and inexpensively. You may not have to answer medical questions, and comprehensive benefits can be provided. Often, a large provider network of physicians, specialists, hospitals, and other medical facilities are included, with out-of-area benefits available.
OE ends in December and begins again each November. If you applied for a health insurance plan in your state, you likely were able to purchase quality coverage with the help of a federal subsidy. Your pre-existing conditions are covered without a waiting period or surcharge, and the cost you pay may be quite a bit lower than ever before. You can also purchase policies outside of the Marketplace without any government assistance. “Catastrophic” plans, although issued through the Marketplace, do not qualify for a subsidy.
New healthcare plans that may be available in 2021, with many additional options that could provide more customized options to meet your specific needs. Although many states allow 24-36 months of continuous non-Obamacare coverage without pre-existing condition coverage, in many other states, only 3-6 months of benefits are allowed. These short-term plans (see below) provide attractive premiums and major medical benefits. But preventative benefits are not free and existing medical conditions are generally not covered. Telehealth and Urgent Care visits may be subject to only a copay.
If you are in good or excellent health, and do not qualify for a federal tax credit, many plans are available from the top-rated companies. Policies with higher deductibles will provide low-cost options that make more financial sense. If there are current medical issues, several policies can still be purchased. Of course, for the proper treatment of chronic and ongoing conditions, a plan from a major insurer will cover more of the expenses. Also, instead of an annual expenses cap of $1 million or $2 million, maximum covered expenses will be unlimited.
However, if you missed Open Enrollment, you can still obtain quality medical coverage from many of the top-rated companies. And the price you pay may be quite a bit lower than you expected. We review below some of the different scenarios that may apply to you. These recommendations will make it easy for you to obtain badly-needed benefits at any time, and secure coverage until the following OE period…or longer. If Administration legislation changes rules, regulations, or plan availability, we will publish complete details.
Temporary healthcare coverage provides immediate major medical benefits for you and any other family member. Since a deductible may be applied to all claims, short-term policies are not ideal for paying for routine or preventive office visits and/or prescriptions. That’s what “Exchange” plans are designed to cover. Graduating students, seasonal employees, and anyone between jobs will often utilize this type of option. If a copay is needed for office visits, prescription drugs, and Urgent Care visits, many carriers offer upgraded plans that include these benefits. There may be a limit of the number office visits covered with a copay.
However, whether you need to wait a few months or as long as 12 months for your next eligibility period, it’s critical that you cover the potential catastrophic expenses that could easily expose you to hundreds of thousands of dollars of medical bills. A temporary policy is ideal for this type of situation and can be easily canceled when you are ready to terminate coverage. Billing is monthly, although an annual-payment discount is offered by several carriers. Thus, by paying for 3-12 months in advance, you may save 15%-25%. The coverage can be canceled by the insured at any time.
Temporary Plan Availability
They are available in all states, although deductibles, rates and policy specifications vary. In some states, you can keep the policy for up to one year without re-applying for another term. In many states, after three or six months, you must apply again if you still need to be covered. Any major change in health could impact the rate or eligibility. Also, taking multiple medications for high blood pressure and cholesterol could also result in a declination. Generally, less-severe conditions, such as asthma, allergies, arthritis, and high blood pressure will not impact the underwriting decision, although expenses or complications resulting from prior treatment, will not be covered.
The entire quoting and purchasing process takes about 15-30 minutes and you can obtain benefits the same day. Although not all big companies offer this type of plan, in most states, UnitedHealthcare (markets plans through Golden Rule subsidiary) and several smaller carriers provide very attractive prices. Our website shows you the lowest available rates in all states. Prices and issuing companies will vary from one state to another. We wrote a special article that provides some great options if you need coverage immediately. Medical underwriting is required (see below).
This stopgap coverage, although very cheap (usually under $80 per month for individuals and under $200 per month for families) is underwritten. That means that unlike Exchange business, you will have to answer several medical questions. If approved (and most applicants are), and you are treated for an illness or injury, it is not likely to be covered. However, any new conditions will not likely be excluded, unless they were due to complications from an excluded condition. Note: 12-month or 360-day policies are more costly than shorter duration plans. Three-year policies are the most expensive option.
Also, “temporary” policies do not include several of the required Obamacare provisions (such as including maternity benefits). Prior to 2019, you were required to pay an extra 2.5% fee (based on your household income), for not purchasing the required plan. Of course, the savings in premiums often outweighed the penalty, especially if you did not qualify for a large subsidy.
The mandate that requires the purchase of coverage ended two years ago. Additional changes to temporary contracts may also be implemented in future years, although individual states often determine eligibility and maximum allowed periods of coverage. Several states have enacted stricter guidelines to limit the length of time a temporary plan can remain in force. Other companies have been forbidden to market their plans in certain states.
Sample Short-Term Medical Plan Rates
Our “sample” scenario is a 40 year-old male in reasonably good health. The policy can be paid on a monthly basis and canceled at any time. The deductible is $2,500 although higher and lower deductibles are offered. 12 zip codes are used. Listed below are the lowest available monthly rates from the zip code where the applicant resides:
79936 – $79
45242 – $44
60629 – $62
48229 – $47
30044 – $95
15214 – $53
28039 – $57
67584 – $37
33125 – $54
64120 – $63
92092 – $143
Limited Benefit Or Discount Coverage
Perhaps the lesser of many evils, “limited benefit” and “discount” policies are widely available. They are fairly affordable and provide basic benefits (LB) that will help pay some of your medical bills. For example, if you experienced a short stay in the hospital with limited procedures and expenses, it’s possible that most of your bills may be covered, depending on the plan you select.
But if your hospital stay is longer, and you need specialized treatment, surgery and/or rehabilitation, these types of plans can leave a gaping hole in your pocketbook. For example, if the entire cost of your treatment is about $100,000, it’s highly possible that more than half of this amount will not be covered. And your out-of-pocket cost will be substantially more than the premiums you pay for the policy. Surgery, anesthesia, drugs, room charges, and physician visits are never fully-covered. Surgery expenses will only be partly-covered.
By their definition, coverage from LB policies are designed to pay some of your bills, but not act as a comprehensive healthcare plan. Thus, if you remain fairly healthy, the concept is somewhat effective. If you are willing to accept capped and restricted benefits, prepayment for many expenses, and predetermined payouts, a LB plan can be considered.
Warning: Often, these types of policies are sold from “boiler room” operations in cities hundreds (or thousands) of miles away from where you live. Employees are generally not insurance-licensed, and training is poor. Typically, they are very reluctant to send a hard copy brochure in the mail, and also urge you to buy their product immediately since a “special deal” will be expiring. You are also asked to pay a frivolous “application” fee that can often cost as much s $200. What is it used for? It’s still one of life’s biggest mysteries.
Qualified Life Events
A “special” enrollment period is awarded if you have a qualifying life event. These situations allow you to qualify for Marketplace plans (with full subsidy entitlement and pre-existing conditions covered) regardless what part of the year you apply. Shown below are some of the most common and likely examples:
* Birth of a child. They can be added to your policy although maternity expenses are not covered.
* Adoption of a child or addition of a foster child.
* Relocate to different area.
* Loss of job (assuming benefits were also lost).
* Divorce. This assumes that your ex-spouse (to be) is the primary applicant on the policy. Also legal separation.
* Medicaid eligibility.
* Existing COBRA is exhausted and expires.
* Termination of your current health insurance policy (by your company and not yourself).
* Death of your spouse or a dependent.
* You change to full-time employment from part-time employment.
* At work, your pay increases to the point where premiums can be withheld.
* After a break from work for more than three days, you are re-hired.
* FEHB benefits are lost by yourself or a family member.
If one of these situations apply to you, generally you have about 60 days to apply for Marketplace coverage (Special Enrollment Period) without answering any medical questions. The available plans will be identical to those that were offered during the original time period. If you miss the 60-day window, you will have to wait until the end of the year to purchase an Exchange plan. You may also choose to apply for short-term coverage until the OE period begins.
Occasionally, you may have to utilize a paper application instead of an online application. When dependents or spouses are added to an existing plan, online enrollment may not be available. But qualifying for the special exemption allows you to choose from plan options that are far more attractive than short-term or limited-benefit choices. In most areas, several carriers offer policies. If you become eligible for Medicare, an additional enrollment period will become available with guaranteed acceptance.
Seniors Who Miss Initial Medicare Enrollment Period
Medicare-eligible applicants that miss the deadline can generally enroll during the General Enrollment Period (GEP) or during a Special Enrollment Period (SEP). If you have not reached age 65 yet, are covered through a family member’s job, and are disabled, you may be eligible, depending upon the size of the employer. The GEP begins on January 1 each year, and ends March 31. Eligible applicants can enroll in Medicare Part B. Benefits begin on July 1, but coverage is not effective until that date, and a penalty may apply.
The Initial Medicare Enrollment Period (IEP) is the seven-month window that surrounds your 65th birthday. By enrolling during the three months prior to your birthday, benefits will become effective the initial month you are eligible. Enrolling in the fourth or fifth month, will result in an effective date the following month. Enrolling in the sixth or seventh month will result in an effective date of the third month following enrollment.
The “Annual Election Period” (October 15th through December 7th) is when changes can be made to your Medigap coverage. If you are covered under original Medicare, you may switch to an Advantage plan, with or without prescription benefits. You may also change your Part D coverage or retain the same benefits. During this time, you can also change Supplement plans.
Certainly, not purchasing any type of coverage is an option. And it is possible that from a financial standpoint, it could result in substantial savings. Of course, it could also backfire, and create a financial quagmire that takes years (perhaps decades) to recover from. And avoiding coverage would still be costly because of the mandate that requires all Americans to buy coverage.
The current 2018 penalty (under age 65) for noncompliance is the greater of 2.5% of household income 0r $325 per person ($162.50 per child). An Individual Shared Responsibility Payment will be required when you pay your taxes. However, if your household income is below 100% of the Federal Poverty Level (FPL), you are exempt from the tax. In 2019, the tax penalty will no longer apply. Therefore, there will be no liability for not enrolling in a qualified medical plan.
The Center for Medicare and Medicaid Services (CMS) has extended Open Enrollment to April 30th. The extra time will begin on March 15th for consumers that did not enroll in a qualified plan and also were assesses the “shared responsibility payment” tax. That extra tax must have been paid when the return was submitted to the IRS.
There are, however, a few caveats. you must agree that you were not aware of the penalty before Open Enrollment ended on February 15th. Also, you must not have already purchased a 2015 Marketplace plan. There is a new box on the IRS tax forms that ask you if you had qualified healthcare the previous year.
It is expected that the Trump Administration’s new three-phase plan to overhaul the current healthcare system, will be tweaked, and will later address issues such as high drug costs and interstate sales. Tax credits will still be offered to lower premiums, and the required mandate to purchase coverage will be eliminated. Open Enrollment periods may be reduced from three months to two months, although exact dates have not been determined.