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Open enrollment under the Affordable Care Act began October 1, 2013 and lasts until March 31st, 2014. This extended 6 month period is for the purpose of allowing those millions not insured extra time to enroll. This coming year, open enrollment will begin November 15th and end January 15th, 2015 which will be the normal open enrollment period going forward. So, what happens once the deadline of March 31 passes? Can you still purchase health insurance or are you locked out until this coming October? The answer is that there are very specific circumstances under which health insurance can still be purchased. These circumstances are described as 'Life Events' and are permitted under what is called a 'Special Enrollment Period' which can occur anytime one of the life events occurs to you or your family. What specifically is meant by Life Events? The following describes these events and are the only ones that qualify for a special enrollment period: Getting married Having, adopting, or placement of a child Permanently moving to a new area that offers different health plan options Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note that quitting other health coverage or being terminated for not paying your premiums is not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.) For people already enrolled in Affordable Care Act coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions The special enrollment period usually lasts for 60 days following the qualifying life event. At this point, it might be helpful to explain what the term referred to above, 'minimum essential coverage' means. In a nutshell, there are two tests a large group plan must pass to meet the minimum essential coverage criteria: Minimum value, which evaluates the comprehensiveness of the plan Affordability, which evaluates an employee's ability to pay for the plan By law, the plan must offer minimum value which is defined as satisfying a 60% actuarial value test - this simply means that a plan would pay for at least 60% of medical expenses on average for a standard population. The affordability test looks at each employee uniquely, not the aggregated population. It compares what employees pay for coverage as a percentage of each employee's wages. The employee's annual premium contribution for self-only coverage for the lowest cost plan cannot exceed 9.5% of employee annual wages. If it does, the plan is not affordable and the employer has failed the responsibility to provide minimum essential coverage for that employee. For example, if an employer charges $200 per month for single coverage, the annual cost of coverage would be $2,400. This plan would be unaffordable to employees with annual wages lower than $25,300. While small groups will not be penalized if their benefits don't meet minimum value, it's still important for these groups to understand these rules. That's because employees who are eligible for employer-sponsored coverage that meets a minimum value are not eligible for federal subsidies on the exchange. Finally, once open enrollment ends, the assumption is that the volume of health insurance business will fall off dramatically because of the very limited circumstances described above that one can still enroll. For most insurance agencies, that void will try and be filled with the sale of ancillary insurance products such a Life, Accident, Hospitalization and Critical Illness and Dental plans. These markets are growing both in demand and products available. Other insurance products that can be sold throughout the year include Senior or over 65 insurance products such as turning 65 Medicare Supplemental or Medicare Advantage insurance. Note that changes in Medicare Advantage insurance products can only be made during open enrollment which is from October 15th until December 7th each year. Elliot is a leading insurance agent with Blue Cross Blue Shiedl of NC and Direct Marketing Associates, an award winning insurance agency serving Asheville North Carolina. Elliot has been providing health insurance plans and information for individuals and employers for over twenty years. Visit http://www.ncinsuranceplansonline.com for rates and information.
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AffordableCare Act, ACA, BCBSNC, Asheville NC, Blue Cross Blue Shield NC, Health plans, health insurance,
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