Open Enrollment to purchase subsidized health insurance in Ohio typically occurs between November and February each year. During that time, no medical questions are asked, and single and family plan rates are reduced by the federal government by using a subsidy in the form of an instant tax-credit. On and off Marketplace coverage is available, so if your income is high, you can still enroll in an affordable plan.
However, if you didn’t watch the news or read a newspaper, procrastinated too long, or simply didn’t have money set aside to buy a policy, you probably missed the OE period. But you can still obtain affordable healthcare benefits. Here are 10 items that will help you secure coverage now, and ensure you won’t miss Open Enrollment next year!
1. Don’t miss Open Enrollment this year! There’s always plenty of advertising in both the print and online media. Generally, if you want your policy to be effective January 1, the deadline is December 15th, so don’t wait after the Holidays to do your healthcare shopping. November 1st is the first day, and it runs through January 31st. If you miss the cutoff, you will probably need an “SEP” (discussed later) to receive favorable treatment.
2. Consider purchasing a temporary Ohio health insurance plan. No, it won’t match the office visit and prescription copays that an Exchange policy offers, but it will provide a very inexpensive stopgap option that is easy on your pocketbook and can be placed in-force within 24-36 hours. UnitedHealthcare is one of many companies that offers low rates. Medical Mutual also offers competitive pricing.
Although temporary policies are ineligible for Obamacare subsidies, for most individuals and families, prices are still less than most Marketplace contracts. And, up to $1 million of coverage can be purchased “per claim” or per “policy period.” You can terminate your benefits with a phone call and utilize a nationwide provider network.
3. Determine if you qualify for a “Special Enrollment Period.” Commonly referred to as an SEP, specific life events that cause a change in family status, allow you to take advantage of this special period of 60 days to secure either subsidized or unsubsidized Exchange coverage. It doesn’t matter if it occurs in January, July, September, or any other month.
Several of the most common “Life Events” include getting married or divorced, reaching age 26, losing existing employer-provided benefits, moving to a different residence, and becoming pregnant. However, in pregnancy situations, the newborn may enroll in a policy, but not either parent. Therefore, prenatal and delivery expenses will not be covered.
4. Be aware of changing OE dates. For example, for 2014 effective dates, the starting date was October 1 2013, and the ending date was March 31 2014. That was six full months for consumers to take about 25 minutes and purchase their coverage. For 2015 effective dates, the starting point was November 15th and it ended on February 15th. The application time plummeted to about 90 days from about 180 days.
And as previously mentioned, the OE period for 2016 is once again, only three months. Although extensions are possible because of occasional glitches and delays, January 31st is the expected last day to enroll. If you already have a policy, you can either keep your plan, or consider switching to a different option.
5. Don’t go without coverage. Just because you didn’t sign up in time doesn’t mean you have to remain uninsured. Although you won’t be able to duplicate Marketplace plan benefits and prices, you can still obtain a medical plan. Major medical expenses are the most important item to cover, and many available contracts will reduce your potential risk against these types of claims.
Short-term contracts won’t eliminate the special non-compliance tax. However, if you develop a serious illness, or have an accident that results in thousands (or hundreds of thousands) of medical bills, you’ll be able to easily cover the vast majority of expenses. And the cost of temporary plans is extremely cheap.
6. Find out in advance which companies accept your physicians and specialists. The most time-consuming and frustrating part of the process is finding a plan that meets your coverage and budget objectives, but doesn’t include your providers.
By contacting doctors and medical facilities in advance, you can ensure that the plan you purchase (even after the OE period) will provide in-network” benefits for routine and scheduled treatment. Since network provider lists change, it’s important to verify your doctor is not dropping the carrier you are using.
7. Stay healthy, and eat your vegetables, especially if you don’t plan to purchase any major medical or catastrophic coverage throughout the year. Don’t go outdoors, don’t answer the door, don’t eat raw meat, and don’t travel in any vehicle with the possible exception of a golf cart.
Of course, we’re being a bit satirical, but any major disease or accident could have a dramatic impact on your financial health. Postponing your medical coverage to January 1st may be too late to treat a serious ailment.
8. Negotiate lower medical bills with your physician, specialist, hospital, and any other facilities you receive treatment. Often, by paying directly in cash, you can reduce your expenses by as much as 50%. And why not? There’s no claim form, insurance company, or approval process that the healthcare provider has to pay for. So everyone is a winner.
Unless, of course, you incur a huge hospital bill you can’t pay. In those situations, you may be able to negotiate a favorable billing alternative that works within your budget. A $10,000 obligation could result in only monthly payments of $100 or less.
9. Do NOT buy a “Limited Benefit” plan. Generally, these are the policies that are underwritten by a company you may not be familiar with. Obtaining specific benefit details are almost impossible, and a mysterious “application” or “enrollment” fee is included. Often, it can be as much as $150-$200. Preventative benefits are not covered at 100%, and a large claim could easily result in tens of thousands of dollars of out-of-pocket expenses.
These contracts are often peddled from boiler rooms that are located outside of Ohio. Your payment information (credit card or check) will be requested on the first contact. Obtaining a refund will be practically impossible, and speaking to a live person becomes much more difficult after they have processed your initial payment.
10. Watch for changes to the ACA legislation from the latest Supreme Court challenge such to Obamacare, such as King Vs. Burwell.The government sided with the original legislation in this decision, although future challenges may also reach the Supreme Court.
The King Vs. Burwell verdict ruled in favor of the legality of federal subsidies offered to residents of states that have not set up their own Exchange. Ohio (and most other states) were at risk of losing these subsidies, which would have effectively doomed the future of Obamacare, unless drastic changes were made.