HealthCare Q&A with Michael Bertrand

Dear Mike,

I’m uninsured.  I know I need coverage, and I’m told I will probably qualify for a subsidy.  But when I called my state’s Exchange, I was told I couldn’t get insurance until “Open Enrollment,” and even then the coverage wouldn’t start until 2015!  What am I supposed to do, stay uninsured until then? - Doug P., San Diego

Doug, you are not alone in feeling frustrated that you can’t purchase insurance from your state’s Exchange right now.  Here at iCan, we get calls every day from people just like you who need health insurance, but are finding out that they can’t get it because of the new Open Enrollment period that applies to most health insurance plans.

For people that purchase their own health insurance, the concept of “open enrollment” might seem strange.  But it’s been a feature of job-based insurance plans for decades.  Basically, what it means is that there is a limited period of time each year during which you can sign up for insurance.

So mark this date on your calendar, Doug:  NOVEMBER 15, 2014.  That will be the first day of the next Open Enrollment period.  On or shortly after that date, I recommend calling one of the licensed insurance agents at iCan to learn about your options, and to see if you qualify for a subsidy to help you out with monthly premiums.  For your coverage to be effective on January 1, 2015, you should call no later than early December 2014!

But you are rightfully concerned about your lack of coverage RIGHT NOW, and there are some options that could be beneficial to you:

First, Open Enrollment is only for what is called “major medical” insurance.  Major medical coverage is comprehensive health insurance that covers a wide range of benefits, including hospitalizations, doctors’ visits, prescription drugs and trips to the ER.  Open Enrollment does NOT apply to other types of insurance, such as short-term medical coverage.  So, one strategy for you might be to purchase a short-term medical policy now to serve as a “bridge” to a subsidized major medical policy.  That would give you some protection if you were to get sick or be hospitalized.

Secondly, you will be able to purchase major medical insurance outside of the annual Open Enrollment period if you have experienced a qualifying life event.  For example, if you lost your job, as well as the coverage you got through your employer – you will be given the opportunity to enroll in a new plan.  Other qualifying life events include birth or adoption of a child, moving to a new state or area, or even a drastic change in your income.  One of iCan’s licensed agents can help you determine if you qualify for one of these Special Enrollment periods.

Next, keep in mind that Open Enrollment does not apply to certain government health programs, such as Medicaid and the Children’s Health Insurance Program (CHIP).  If your income is low enough to qualify, you should be able to enroll in those programs at any point during the year.  Contact your state’s Medicaid office for enrollment information. 

Lastly, if you just turned 65 or will be turning 65 this year, you can enroll in Medicare.  Individuals can enroll in Medicare during the month they turn 65, during the three months before the month they turn 65, and during the three months after the month they turn 65. 

The new rules around health insurance can seem frustrating at times.  But remember, help is just a phone call away.  And, always remember, some type of coverage is better than no coverage at all!

Michael Bertrand is the Government and Industry Relations Director for the iCan Benefit Group. An attorney by trade, Michael spent several years as an insurance regulator and served as Vermont's Commissioner of Banking, Insurance and Health Care Administration from 2010-2011, wherein he regulated the insurance industry in the state of Vermont and its fourteen (14) hospitals. The information or opinions contained herein are for informational purposes only as a service to the public, and is not legal or tax advice, or a substitute for legal or tax counsel.