During the months of Open Enrollment the insurance companies have to take everyone who applies, lives in a county they serve and pays their premiums. It doesn’t matter what surgeries you need, health conditions you have or medications you are taking. You could be scheduled for a liver transplant, or be treating for cancer and the insurance would have to cover you.
But once the time period of open enrollment ends, you no longer have the right to buy individual health insurance or switch plans. That is, unless the reason you want to buy it now is acceptable to either the WAHealthPlanFinder or the insurance company. If your reason for buying health insurance now is that you just moved to Washington State, or you had a baby, or you got married – great. If your reason is that you lost a job and lost group insurance, or retired early or got divorced, or for some reason lost group coverage… generally you can get an individual plan. … as long as you do it within 60 days of when your reason happened. The accepted reasons are a little different between each company and for the WAHealthPlanFinder. So a good broker like, Highlands Insurance Solutions, will help people to know which companies or if the WAHealthPlanFinder will accept their reason and will facilitate getting you through all the red tape.
Here are some scenarios of our clients who didn’t enroll in coverage during Open Enrollment and now want coverage. (All identifying information has been changed to protect privacy.)
The Hans are a couple who came in at the last week of April. They just moved here from Korea, arrived April 15th. Have a home in Sammamish, and got a driver’s license in 10 days. Pretty impressive. Health insurance was a bit more complicated. The do have a strong income and are hoping to have a second child maybe next year. Since they are new residents to WA State, they have the right to buy health insurance. We worked through the WAHealthPlanFinder to find a plan that gave them access to local doctors and hospitals, and would have good prenatal coverage if their hopes become reality. I was able to tell them what residency and immigration documents were needed and upload those for them. After entering their application on line, we made a quick call to the WAHealthPlanFinder to open their Special Enrollment Period, and we were ok to purchase the insurance plan they chose.
The Mani family was similar. Raj works at Microsoft and sponsored his brother and sister-in-law to join him in America. They arrived from India March 30th and while his brother plans to get a job, brother and sister-in-law are currently living on a very modest income. If they had lived here for 5 years or more they would have qualified for Washington Apple Health (Medicaid), but as new arrivals, they only qualify to purchase a health plan, though they will get a subsidy to help with the premium. We were able to get them through the bureaucracy of the WAHealthPlanFinder and select a plan.
We’ve worked with several couples and individuals who have lost group coverage either because of a job loss or because they retired early. With the Colts we were able to help them prepare ahead of time. They weren’t sure what Dan’s employer’s response would be to his 2 week notice. Leave now, or work the remaining 2 weeks. So we were prepared for both. That took a lot of stress and worry from Judy’s mind.
With Tom Peters, he emailed us the last day of the month. He’d been without insurance all of April after losing his job at the end of March. He now has a new job, but it doesn’t have insurance. In one day we narrowed down the type of plan that worked best for him in his budget, confirmed his doctor was in network, completed his application and got him covered for May 1st.
On the other hand, Holly called us near the end of April. She wanted to buy health insurance. She hadn’t had insurance since December 31st. She had a new job starting up in July with insurance but had finished up her taxes and heard about the penalty for not having insurance. So she wanted to buy a plan for the next 2 months. Sadly it was outside of open enrollment and her reason for not already having a plan was more than 60 days old. We could help her get covered for injuries or accidents with temporary insurance, but not with a plan that fulfills the Obamacare law. She’ll likely get penalized when she does her 2015 taxes for the months before her employer insurance kicks in.
Each client comes to us with a story; a life with joys and challenges. Our calling as Highlands Insurance Solutions is to help tell that story to the insurance carriers and WAHealthPlanFinder when a client qualifies for a Special Enrollment Period.
– Julia Cooke