Health Insurance Question

[dfchelbay]

So, tomorrow is open enrollment deadline to get health insurance. If you don't get it by tomorrow, then you can't get it until 2016. I just saw a commercial on tv that stated that you cannot make changes to your insurance either until 2016. I was puzzled about a few things when I saw this. Here is what I'm wondering about:

1. If you buy a policy now, but you get a job with benefits in a few months, can you change to employer policy, or will you have to wait until next open enrollment?

2. If you buy the least expensive policy now with high deductible, are you not allowed to change to better coverage, lower deductible policy in 6 months because you are more financially able to?

I guess I'm most curious about people buying crappy policies now because that's what they can afford & don't want IRS penalty, then getting a better job with insurance benefits, but being forced to keep crappy policy until 2016 open enrollment.

It's sad that if you didn't or don't have the cash during open enrollment, but will have it next month, or 2, 3, 4, months from now you are barred from buying any medical insurance until next year. There are so many people that are seasonal employees & get paid nothing or only get unemployment compensation 3 months of winter (which happens to be same time as open enrollment) and may not have funds during that time frame. Another example is if you're between jobs and get a really great one in a couple months. You don't have the money right now, but you will in a few months, you're not allowed to buy health insurance until next year. Thoughts?

 

[scrapquitler]

So, tomorrow is open enrollment deadline to get health insurance. If you don't get it by tomorrow, then you can't get it until 2016. I just saw a commercial on tv that stated that you cannot make changes to your insurance either until 2016. I was puzzled about a few things when I saw this. Here is what I'm wondering about:

1. If you buy a policy now, but you get a job with benefits in a few months, can you change to employer policy, or will you have to wait until next open enrollment?

2. If you buy the least expensive policy now with high deductible, are you not allowed to change to better coverage, lower deductible policy in 6 months because you are more financially able to?

I guess I'm most curious about people buying crappy policies now because that's what they can afford & don't want IRS penalty, then getting a better job with insurance benefits, but being forced to keep crappy policy until 2016 open enrollment.

It's sad that if you didn't or don't have the cash during open enrollment, but will have it next month, or 2, 3, 4, months from now you are barred from buying any medical insurance until next year. There are so many people that are seasonal employees & get paid nothing or only get unemployment compensation 3 months of winter (which happens to be same time as open enrollment) and may not have funds during that time frame. Another example is if you're between jobs and get a really great one in a couple months. You don't have the money right now, but you will in a few months, you're not allowed to buy health insurance until next year. Thoughts?

Generally (at least in the past) any "change of life event" like getting a new job that offers different coverage, getting married, getting divorced, having a baby, moving out of state (since insurance policies generally don't cross state lines) gives you an expemption from the 'you can't make any changes to your insurance' policy.

 

[dfchelbay]

Yeah, all I could find was "losing job based insurance" was life changing event, nothing really about gaining job with insurance as being life changing event.

 

[staceyeileen]

Yep, if you get a new job with insurance you can just cancel your marketplace plan and sign up with the employer's plan. I did this in September. In fact, they really didn't even need or ask for any kind of proof of my new job/insurance - I just called up the healthare.gov people and said I needed to cancel my plan.

 

[mj70148]

Just like any other plan, you can't change anything around during the year. So if you opted for the "crappy" plan to start with, that's what you have for the year. That's why we always have to sit down and really think about our options for a while before finalizing anything. Nobody can tell you what your year will look like, and even the best plans (we wanted to have a baby this year) can be changed for various reasons. So that part of your question goes for ANY health/dental/vision plan you select.

As far as your frustration with timing and limited funds, such is life. Do you qualify for Medicaid? If you are really struggling financially, that may be a great option. At the end of the day, prioritizing your spending with what you DO have may need to happen (this comes with planning ahead - like, "hey, a year from now i know i'll need a sum of money to pay for health ins. so i'll start saving now".) It's easier said than done I know- sorry if I'm preaching to the choir!

 

[tvguy]

moving out of state (since insurance policies generally don't cross state lines)

Okay, I'm no expert but best I can tell, since 1996 with the passage of HIPPA health insurance policies HAVE to cross state lines. And I'm also no expert on the Affordable Health Care Act, but much was made at the time it was passed about portability of benefits.
But in my situation, I have worked the past 26 years for corporations that have locations across the nation that have one insurance plan, so their plans HAD to cover all the states they had operations. Granted, since many were east coast based, our options in California often were limited. Like, literally one PCP that accepted our plan, and sometimes, no specialists in network.

 

[staceyeileen]

Just like any other plan, you can't change anything around during the year.

I understand what you're saying and that has traditionally been how it's worked with open enrollment on an employer's plan. You're locked in, and since you're paying your portion of the premiums through payroll deductions they've got your money. However, since these marketplace plans are basically just private individual insurance plans, they can be canceled whenever you want. Like I said, I called up and said I want to cancel my plan. It was canceled effective that day, no questions asked. I even got a refund for the remainder of the month that I had already prepaid.

 

[staceyeileen]

From https://www.healthcare.gov/apply-and-enroll/change-after-enrolling/

Cancelling your plan without replacing it
You can cancel a Marketplace plan without replacing it at any time. But there are important things to consider before you do this.

If you cancel your health coverage without replacing it, you may have to pay a fee for the months you’re not covered. There are also important health and financial risks if you don’t have health coverage. Learn more about why it’s so important to have health coverage.

To cancel your coverage, log in to your Marketplace account and select the red “Terminate/end all coverage” button.

 

[scrapquitler]

Okay, I'm no expert but best I can tell, since 1996 with the passage of HIPPA health insurance policies HAVE to cross state lines. And I'm also no expert on the Affordable Health Care Act, but much was made at the time it was passed about portability of benefits.
But in my situation, I have worked the past 26 years for corporations that have locations across the nation that have one insurance plan, so their plans HAD to cover all the states they had operations. Granted, since many were east coast based, our options in California often were limited. Like, literally one PCP that accepted our plan, and sometimes, no specialists in network.

I'm not sure...as far as I know, my policy states that it is only available for those who live in CT, it's a BCBS policy.

 

[tvguy]

I'm not sure...as far as I know, my policy states that it is only available for those who live in CT, it's a BCBS policy.

Only available for purchase in CT I assume you mean. It will pay claims no matter where you get treatment in the U.S, right?

 

[Laurie5013]

2. If you buy the least expensive policy now with high deductible, are you not allowed to change to better coverage, lower deductible policy in 6 months because you are more financially able to?

No, you can't. This is to prevent people from changing plans to a lower deductible when they get sick. Hope that makes sense?

 

[CyndiLooWho]

Only available for purchase in CT I assume you mean. It will pay claims no matter where you get treatment in the U.S, right?

Maybe, maybe not. Ins companies get around this with the "preferred provider" clause. I can go to any dr I want, but if I go to one that does not participate with my ins, I have a separate (read "much higher") deductible to meet. Ins cos typically only negotiate with providers in their home area or state. For instance, a Louisville KY company may offer to cover drs in both Kentucky and Indiana, b/c it just takes 5 minutes to cross the river, and many of their employees are in Indiana. My dh's company offers different insurance in most states they operate in, b/c there are very few companies that cover most docs in most states.

Even in your home state, you can get burned. My ILs opted to get out of standard medicare and were talked into taking a high deductible policy (dh is getting medical poa next year to keep them from getting screwed again). Of course, FIL was dx'd with cancer and had to have extensive treatment. When it came time to get medical equip to take home, the rental co that had the machine he needed did not participate with his ins, and he had to meet a second deductible just for that machine. In effect, he had no coverage at all for that piece of equipment, as he only needed it for about 6 wks, and the out-of-network deductible was about $6000. He didn't have any idea the hosp that was covered under his ins would go to a company that was not covered. And the hosp can't possibly know the ins and outs of every policy.

To the OP, life changing events will always allow you to change your policies. It's just that you can't randomly jump into and out of the insurance game b/c of health or finance reasons. That's the reason there is an open enrollment period.

 

[PatMcDuck]

Just to say, we had to get my daughter coverage thru the Marketplace starting last year. (DH retired, so she was kicked off his plan on her 22nd birthday, it's a loophole).

We live in NJ. NO Horizon/BC BS PLANS offered would cover any NYC doctors. I looked high and low, and even called Horizon, they said no to NYC except for regular employer based plans. Some marketplace plans did cover some Drs in Philadelphia. (She was able to find a doctor who trained with and is friendly with her NYC orthopedist, so that was a relief.) We got her a Silver plan, no deductible, $10 copays. We looked at the plans carefully, she is healthy now but had serious health issues as a teenager.

One "loophole" we DID discover..... she actually qualified for Medicaid, but I did not want that for her. (DS is handicapped and on that and its tough to find specialists in some fields who take it). So we said she would make MORE $$, so she just qualified for the regular plans. Its nearly impossible to estimate PT income anyway, and she took a 2nd PT job that did not work out, which would have put her closer to that #. She is still a FT student, but no longer our dependent. There is no penalty for overstating income, just for understating it.

We hope she has a FT job with benefits by the end of this year.

 

[tvguy]

Maybe, maybe not. Ins companies get around this with the "preferred provider" clause. I can go to any dr I want, but if I go to one that does not participate with my ins, I have a separate (read "much higher") deductible to meet. Ins cos typically only negotiate with providers in their home area or state. For instance, a Louisville KY company may offer to cover drs in both Kentucky and Indiana, b/c it just takes 5 minutes to cross the river, and many of their employees are in Indiana. My dh's company offers different insurance in most states they operate in, b/c there are very few companies that cover most docs in most states.

Even in your home state, you can get burned. My ILs opted to get out of standard medicare and were talked into taking a high deductible policy (dh is getting medical poa next year to keep them from getting screwed again). Of course, FIL was dx'd with cancer and had to have extensive treatment. When it came time to get medical equip to take home, the rental co that had the machine he needed did not participate with his ins, and he had to meet a second deductible just for that machine. In effect, he had no coverage at all for that piece of equipment, as he only needed it for about 6 wks, and the out-of-network deductible was about $6000. He didn't have any idea the hosp that was covered under his ins would go to a company that was not covered. And the hosp can't possibly know the ins and outs of every policy.

To the OP, life changing events will always allow you to change your policies. It's just that you can't randomly jump into and out of the insurance game b/c of health or finance reasons. That's the reason there is an open enrollment period.

My experience is likely different since DW and I work for corporations who buy group coverage to cover employees who work at locations across the nation. Although a past employer did offer vision insurance that nobody in our state accepted.

 

[staceyeileen]

We live in NJ. NO Horizon/BC BS PLANS offered would cover any NYC doctors. I looked high and low, and even called Horizon, they said no to NYC except for regular employer based plans. Some marketplace plans did cover some Drs in Philadelphia. (She was able to find a doctor who trained with and is friendly with her NYC orthopedist, so that was a relief.) We got her a Silver plan, no deductible, $10 copays. We looked at the plans carefully, she is healthy now but had serious health issues as a teenager.

One "loophole" we DID discover..... she actually qualified for Medicaid, but I did not want that for her. (DS is handicapped and on that and its tough to find specialists in some fields who take it). So we said she would make MORE $$, so she just qualified for the regular plans. Its nearly impossible to estimate PT income anyway, and she took a 2nd PT job that did not work out, which would have put her closer to that #. She is still a FT student, but no longer our dependent. There is no penalty for overstating income, just for understating it.

Just curious, what is wrong with NJ doctors? Also, seems strange that your DS is on Medicaid but it's not good enough for your daughter? Maybe I'm reading that wrong. I'd jump at a chance for free insurance.
You got a Silver plan with no deductible and $10 copays?! That is definitely a platinum plan in my state.