Special Enrollment Period – Losing Health Coverage

In follow up to our last blog post regarding Special Enrollment Periods (SEP) we wanted to look further into some specific ones that are most common. The most common SEP qualification we are seeing is for individuals that have lost or will lose their health coverage from their employer.

Since we are outside of the Annual Enrollment Period you must have a qualifying life event (QLE) in order to purchase coverage on the North Carolina health insurance marketplace. If you are losing your employer health insurance involuntarily you have a 60 day window to purchase health insurance on the marketplace either before or after the event occurs. This is the only QLE that you can purchase coverage before the event occurs.

Let’s look at a few scenarios to further illustrate:

Scenario 1:

John’s employer terminates the group coverage effective May 1, 2014. John contacts us on July 15th to apply for coverage.

Result: John CANNOT purchase coverage because he is past his 60 day enrollment period and will have to wait until November 15, 2014 to apply (start of the next AEP) for coverage to start January 1, 2015 or until he has another QLE.

Scenario 2:

John’s employer terminates the group coverage effective May 1, 2014. John contacts us on April 30 and we submit an application.

Result: John can submit an application prior to 60 days of the QLE occurring. In this scenario because he did it before the new month his coverage will start on May 1, 2014 preventing any gaps in coverage

Scenario 3:

John’s employer terminates the group coverage effective May 1, 2014. John contacts us on May 15 and we submit an application.

Result: John can submit an application up to 60 days after the QLE has occurred. However in this instance his coverage will start on June 1, 2014 leaving him 1 month without coverage

As the above scenarios illustrate it is best to contact us about 30 days prior to the group coverage being lost (typically due to termination of employment, employer no longer offering health benefits, changing jobs, or dependent turning 26 and aging off parents plan).

Remember this is the only QLE that you can apply prior to the event occurring. All other QLE’s the event has to occur first then you have 60 days to apply.

Enrolling in Obamacare in NC outside of Enrollment Period

We are still getting a lot of inquiries for people looking for coverage. Times have changed with the Affordable Care Act (aka “Obamacare”) in that you now can’t just buy coverage whenever you want. The initial Enrollment Period for coverage starting in 2014 was from October 1, 2013 – March 31, 2014.

If you missed this enrollment period you will have to qualify under a “life event” that will trigger a Special Enrollment Period (SEP). In order to obtain coverage during the SEP you must meet at least one of the following criteria:

• Losing health insurance provided by your employer
• Recently moved
• Aging off of a parent’s plan (at age 26)
• Expiration of COBRA
• Losing a job
• Leaving incarceration
• Divorce
• Birth or adoption of child
• Gaining citizenship
• Losing eligibility for Medicaid
• Getting married
• Complex Situations (will be covered in later post)

Please note that you have a 60 day window to enroll during the SEP. We recommend that you contact us well before the event occurs, if possible, so that we can plan your enrollment process to make it a much smoother experience for you.
If you feel that you meet the criteria for an SEP please complete the form to the right of this article.

Obamacare – Who will it help, who will it hurt?

With Healthcare reform, also known as Obamacare, quickly approaching (less than 48 days), our goal is to help you understand the impact the law with have on you.  The law will change how you access insurance in the near future.  Whether you are for or against the law, it’s important to understand how it will impact you.  Each person’s situation is different, so the law’s impact will vary.

obamacare facebook ad v4

 

Please note, this is a discussion on your coverage and premium impacts, not a political discussion on what effects this law may or may not have on the economy.

Below are some situations that will be affected either positively and negatively.  Although these are not all the possible scenarios, these will give you an idea of what may apply to you.

Who will it help?  The following will likely see rate decreases or will now have the ability to purchase health insurance.

  • Those who were declined previously and could not get coverage in the private market. – This group will be able to purchase health insurance without worrying about being declined because of health conditions (pre-existing).  There will be no waiting period for pre-existing conditions either.
  • People who were rated higher than the standard rate – Those who were not declined, but charged more for their coverage will lose that excess charge when the new law starts.  Companies have several rate levels that are higher than the standard quoted rate.  These people will see that rate charge dropped because the law will not longer allow for rate increases based on the customers health.
  • Older people (ages 55 to 64) – this group will likely see rate decreases because of the age banding the law requires.  The age banding requires the premiums of a 64 year to be no more than 3 times that of a child’s rate.
  • Those who qualify for a subsidy (subsidy chart) – If your household size and income fall somewhere on this chart and you do not have access to affordable group coverage, you will likely qualify for a subsidy.  This will offset the premiums costs for coverage under the new law.
  • Families with more than 3 children – The rating structure of the law allows for premiums to include the cost of the three oldest children.  For families with more than 3 children, premiums will only include the cost of the parent(s) and the three oldest children.

Who will be hurt by the new law because of rate increases:

  • Healthy people – If your current premium is discounted based on your great health, you will likely see a higher charge for coverage under the law.  Since the law requires no rating for those with health conditions, it will also not allow rate reductions for those who are very healthy.
  • Younger people whose income is outside of the subsidy chart – If your income is above the 400% Federal Poverty Level, you will not qualify for a subsidy and will pay the full cost of the coverage.
  • Single people with high incomes – Single people with high incomes and no kids will likely pay more for coverage under the law.  They will not qualify for a subsidy due to the high income and the lack of children will not allow them to get a lower
  • Dependents who have access to affordable group coverage – If you have a spouse that has group coverage that is deemed affordable, you will not qualify for a subsidy and will either purchase coverage through your spouse’s employer or purchase coverage outside of the exchange.

If you have any questions, you can message us on Facebook or contact us through our website.  Again, our intent to not debate the pros and cons of the law, but to give an unbiased review of what options North Carolinians will have once the exchange opens.  Will it be good for some and bad for others; yes, but it will be here October 1st.   North Carolinians will need to know what their options are.

The first Annual Enrollment Period (when enrollment starts) will run from October 1st to March 31, 2014.  In order to get a 1/1/14 effective date, applications must be submitted to your desired insurance company by 12/15/13.  If you decide not to enroll in creditable coverage, you will be locked out until next year’s Annual Enrollment Period.  Certain Special Enrollment Periods (married, lose job, etc) will allow you to enroll in creditable coverage mid year.

If you feel the need for additional help, please complete our “Reserve Your Appointment” form on the right hand side of the website.  We will add you to our growing list of people to contact once the exchange opens.

Obamacare Explained in Video

The Patient Protection and Affordable Care Act (PPACA), aka Obamacare, is a very confusing and overwhelming law that has many people up in arms.  While many hate it, some love it, and some are indifferent the fact of the matte is as of today it is here and will be in full swing starting January 1, 2014.

As professional health insurance agents we aren’t here to defend the law.  Rusty and Kent’s role is to make sure our clients understand the implications and the benefits that this will impose on them.  In doing some research we came across this video produced by the Kaiser Foundation that we thought really did a good job of explaining the gist of what is coming

Take a few minutes and watch this video as it should clarify a lot of your questions.  Enrollment will begin in 53 days and will be a VERY hectic time period so if you would like to be on our list to follow up with to go over your options please make sure to fill out the appointment form on our home page.  Enjoy.

 

How Do I Buy On The NC Health Care Exchange?

One of the confusing factors with Obamacare starting in 2014 is how do you buy coverage on the NC health care exchange?  The main determining factors are whether or not you have health insurance options from an employer (either through you or a spouse) and what is the modified adjusted gross income (MAGI) for the household.

Here is a flow chart that tries to simplify this mess a little bit (click on picture to make bigger so you can see it):

obamacare flowchart v1

To determine if your MAGI qualifies you for a government subsidy click here.  Once this is determined then you will know whether or not you qualify for the premium reduction.  All this will be a pretty seamless process behind the scenes since you will not see the subsidy; it will just be subtracted from your monthly premiums.  These reductions for many will be substantial allowing for affordable coverage.

If you have employer coverage available chances are you would not qualify to buy coverage inside the exchange for anyone in the family.  Why is this?  Well by law your employer has to pay at least 50% of the employee’s premium.  With the employer covering such a high percentage this will make most employee’s coverage be lower than the 9.5% used to determine affordability by CMS.  We think this is a flawed measure by not counting in what it costs for the family to be on the plan….but it is what it is at the time.

Click here to learn more about your NC health care exchange options.

Do you qualify for a subsidy with Obamacare?

As we get closer to the start date for enrollment with Obamacare (October 1st), many people are starting to learn the ins and outs of how this will affect them.  Estimates are that 2/3 of North Carolinians will qualify for some form of subsidy under the new law. How do I know if I qualifyContinue Reading

When does Obamacare in NC start?

Open enrollment for plans offered through the NC health insurance exchange starts on October 1, 2013 with coverage starting on January 1, 2014.  This initial open enrollment period will run through March 31, 2014.  After this date enrollment periods for health coverage will coincide with Medicare’s open enrollment period each year which is October 15Continue Reading

More to come!

With healthcare reform (often referred to as “Obamacare” in the media) fast approaching, this site will quickly ramp up to speed to help North Carolinians understand their options.  A tremendous amount of guidance continues to be released from the Health and Humans Services Department (HHS) each week.  This guidance gives us more details on howContinue Reading

Please note....At time of publication, this information is accurate. There is no guarantee Federal interpretations of ACA will not change prior to full implementation after 1/1/14.