Ohio Open Enrollment for single and family Obamacare health insurance plans ended on March 31 2014. In 2015, it will end on February 15th. After those dates, you need to purchase a plan through a “Special Enrollment,” that allows you to qualify for available federal subsidies and have any pre-existing condition covered without proving insurability.
What Is A “Special Enrollment” In Ohio?
This refers to specific situations that allow Buckeye consumers to buy policies outside of the normal period. For about 60 days, all Exchange plans that are offered on the Marketplace will be available, regardless of what time of the year this occurs. ACA tax subsidies will apply and there will be no extra fees or charges. To take advantage of these “special” situations, you must have a “qualifying life event.”
Your enrollment eligibility is not impacted by your income (unless you are Medicaid-eligible). Thus, if you have a high income that excludes you from receiving a tax subsidy, it will not affect your right to purchase a policy during this special period. Of course, if you apply during the OE period, you can view specific tips and information here. And you won’t need a special exemption.
What Are The Qualifying Events?”
No Longer Eligible For Medicaid - If suddenly (for income reasons), you lose Medicaid eligibility, you can enroll. Keep in mind that Medicaid is different than Medicare. Medicare is for persons that have reached age 65 and are no longer working or are not covered under another plan.
Birth of a child – This would refer to the newborn, and not the parents of the child. Premiums should be low because of the young age. If the child is born with any type of medical problem, the cost of treatment will be covered. Adoption is also an approved exception, although the appropriate documentation will be needed.
Divorce – This refers to the ex-spouse that is losing their coverage and does not impact the other ex-spouse’s existing plan. You can choose to duplicate (or closely duplicate) benefits, or choose an entirely different plan option.
Cancellation Of Current Plan – Many in-force policies are being terminated with an option to convert to a different policy. Often, the conversion option is extremely expensive and has out-of-pocket costs that don’t match your budget. You may instead, compare Exchange plans that are eligible for the full federal subsidy. Notification of termination usually gives you at least 30-60 days to change policies.
COBRA expires – If you have exhausted your COBRA benefits (usually for 18 months), you no longer have to select a HIPAA plan. Previously, you faced an exorbitant premium that was often higher than COBRA. But starting in 2014, that ended. Now, it is a covered exception and there are many available plans. Most should be less expensive than COBRA.
Marriage - Regardless of age (must be under age 65), this qualifies. Usually, one spouse loses their coverage, especially if the policy is an employer-sponsored group plan. You may have to change carriers and possibly find a new doctor, depending on which company you choose.
Termination of employment – One of the most common situations is when a job is lost. At least you won’t have to worry about medical issues since coverage is guaranteed. If the number of hours you are working is reduced, and the result is a loss of benefits, this will also qualify.
Retirement – If you are retiring from your employer and have to select your healthcare options, you are eligible. You may have an option to convert your group plan and that should also be considered. If you are offered a policy by a new employer, you forfeit the right to purchase a policy through SEP.
Move – If you permanently move to a different location which utilizes a different insurer and creates different policy choices, you may select another plan. Keep in mind that your rate could dramatically fluctuate. For instance, a move from Ohio to New Jersey would not put a smile on your face. Conversely, if you move from New Jersey (or New York) to Ohio, you’ll have more spending money! Most Northeastern states tend to be more expensive than other parts of the US.
Error – If during your last enrollment, an error occurred, it’s possible you may be able to earn an exception. You will be asked to provide documentation and possibly details of the date you spoke to the representative.
“Minimum Essential Health” Benefits Were Lost – These are the 10 basic requirements of all Metal Exchange plans. Other than non-payment, lapse or forgetting to enroll, when any of these benefits are lost from your current plan, this exception may qualify. Maternity is expensive, and if it is removed from your policy, you will probably be able to select another plan. The assumption is that your existing policy was compliant before the removal of benefits.
Reach Age 26 – If you have been covered under a parent’s policy, when you reach 26, you’re entitled to your own policy. Of course, you do not have to wait until January to apply for the new plan.
Not Eligible For Special Enrollment – Go Short-Term
If you don’t qualify for any of the exceptions listed above, there is a very low-cost policy available to both individuals and families at any time of the year. Referred to as “short-term” coverage, these temporary contracts will provide the cheapest Ohio health insurance coverage you can purchase. Not all companies underwrite the policies, but there are several trusted carriers that can be used.
The Positives - The price. As earlier mentioned, it’s cheap and we’ll show some specific examples below. The simplicity. The 12-page applications have been removed, and replaced by a short form with about 3-5 medical questions. If you haven’t been treated by any of the conditions, and you have not been previously denied for coverage, you will automatically (Well…almost) get approved.
If you need coverage quickly, your wait time will be less than 24 hours and an application can be completed in about 10-25 minutes. You can complete the easy form online, or we can email or fax the application. No physical is required and only limited medical information is needed.
Short Term Plan Pricing
And the cost! It’s very inexpensive. The major companies in this niche are Anthem Blue Cross, UnitedHealthcare, Assurant, IHC Group and HCC Life. Estimated monthly premiums for a 35 year-old male living in the Daytona are area are listed below:
$36 – $5,000 Deductible
$34 – $2,500 Deductible
$40 – $1,000 Deductible
(Lower coinsurance will increase premium)
The Negatives – If you have any existing conditions, it’s likely they will not be covered. And although preventive benefits are mandated (required by law) to be covered on healthcare plans, the short-term plan is exempt, so you would have to pay for your own annual physicals, OBGYN visits and mammograms.
Also, since it is not Affordable Care Act compliant, you may be subject to a 1% (household income) tax for not purchasing a Marketplace policy. Although we would prefer this tax is waived, in many situations, the money that is saved, far exceeds the 1% penalty (which is scheduled to increase to 2.5% in 2016).
These types of policies are not designed to pay for long-term treatment of chronic illnesses and diseases. In addition to expensive therapy that may be limited, expensive non-generic drug use could create some challenging financial situations. Other benefits, such as maternity and chiropractor visits are often not covered either.
Regardless of the reasons you missed Ohio Open Enrollment for Obamacare, there are low-cost options that will allow you to quickly purchase coverage and get covered. We’re here to help.