Open Enrollment for Obamacare health insurance lasts about three months. 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. And you may not have to answer any medical questions.
OE ends in January and begins again in 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 now covered and the cost you pay may be quite a bit lower than ever before. You can also purchase policies away from the Marketplace and without any government assistance.
If you are in perfect 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.
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 Trump Administration legislation changes rules, regulations, or plan availability, we will publish complete details.
Temporary healthcare coverage will provide immediate major medical benefits for you and any other family member. Since a deductible must 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.
However, whether you need to wait a few months or as long as 6-9 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.
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 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 medications for high blood pressure or cholesterol could also result in a declination.
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, Blue Cross, UnitedHealthcare and some smaller carriers provide very attractive prices. Our website shows you the lowest available prices in all states. We wrote a special article that provides some great options if you need coverage immediately.
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 a few medical questions. If approved (and most applicants are), and you are being treated for an illness or injury, it is not likely to be covered. However, any new conditions will not likely be excluded.
Also, “temporary” policies do not include several of the required Obamacare provisions (such as including maternity benefits). Thus, you may have to pay an extra 2% fee (based on your household income), for not purchasing the required plan. Of course, the savings in premiums may outweigh the penalty, especially if you do not qualify for a large subsidy.
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. 10 random zip codes are used. Listed below are the monthly rates, underwriting company, and zip code where the applicant resides:
79936 – $81 from HCC Life
45242 – $83 from Assurant
60629 – $85 from HCC Life
48229 – $86 from UnitedHealthcare
30044 – $59 from HCC Life
15214 – $86 from HCC Life
20784- $106 from Assurant
28039 – $104 from UnitedHealthcare
58775 – $70 from HCC Life
67584 – $141 from IHC Group
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, most of your bills could be covered.
But if your hospital stay is longer, and you need specialized treatment, surgery and/or rehabilitation, these types of plans will 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.
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. But it does not comply with the Affordable Care Act legislation requirements, and thus, just like temporary plans, a special household tax of 2% is imposed.
Warning: Often, these types of policies are sold from “boiler room” operations in cities hundreds (or thousands) of miles away from where you live. 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. Hogwash, of course. 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.
Occasionally, you may have to utilize a paper application instead of an online application, and the enrollment quota may be full for several specific plans. But qualifying for the special exemption provides you to choose from plan options that are far more attractive than short-term or limited-benefit choices.
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 2015 penalty for noncompliance is the greater of 2% of household income 0r $325 per person ($162.50 per child). This penalty (tax) gradually increases each year to place a little more pressure on consumers to buy health insurance. 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.
February 20 2015 – The Center for Medicare and Medicaid Services (CMS) has extended 2015 Open Enrollment to April 30th. The extra time will begin on March 15th for consumers that did not enroll in a qualified plan for 2014 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 2014 IRS tax forms that ask you if you had qualified healthcare the previous year.