15
APR
2014

HEALTH CARE REFORM: NOW WHAT?

comment : Off

2014 OPEN ENROLLMENT WRAP UP:

The Federal Government reported 7.6 million people enrolled in health insurance through the Marketplace as of March 31 and 8.6 million as of April 15th. Keep in mind not all of these were new people to health insurance. Many dropped their individual health insurance plans in order to pick up a subsidized health plan, if they qualified for the subsidy.

The purpose of this communication is to answer the question, “Since the open enrollment period is over, now what?”

SPECIAL ELECTIONS:

The only way to obtain health insurance for this year after March 31st is with a Special Election Period (SEP). Examples of events that create special elections are; marriage, birth, move to an area outside your current policy’s coverage area, or loss of health insurance due to divorce, death or employment termination. Also you can gain a special election is you are a new US citizen or are released from incarceration. There’s a special election for victims of domestic abuse and for “exceptional circumstances determined by CMS. For example, I have one client who’s ex-husband was court ordered to pay for her health insurance. Her policy terminated when he stopped paying without her knowledge. When she tried to use her policy in July she discovered she was no longer covered. CMS stated that this loss of coverage was through no fault of her own. However, if you lose coverage because you forgot to pay your premium, you won’t be able to be reinstated this year!

Most special elections are good for 60 days after the event. An exception is the SEP for non-calendar year renewal of an individual policy. This SEP is good for 30 days prior to the renewal date.

I SUCCESSFULLY ENROLLED IN THE MARKETPLACE. DO I NEED TO DO ANYTHING ELSE?

The Marketplace asked many enrollees to supply proof of their 2014 income, or their citizenship, or legal residency or event that created an SEP. Those requests must be addressed or your policy can be terminated. This isn’t always easy. You are given the option of uploading the requested documents from your Marketplace account or mailing them. Most people I worked with were unsuccessful in electronically uploading their documents. The Marketplace has been very poor keeping track of documents. Many people have had to send the documents multiple times, even after getting confirmation of receipt. Here are a few suggestions to maximize the successful receipt of mailed documents.

  1. Put your Marketplace ID number and your Social Security number on each page of the documents sent. (Remember to only send copies; not originals!) This ID number is on the front page of your subsidy determination letter, and also should be on all communications from the Marketplace.
  2. There is a bar code on either page 8 or page 9 of your subsidy determination letter. Include a copy of this with your documents.
  3. Mail your document package Certified Mail with Confirmation of Receipt. Getting the receipt that your package was delivered to the Marketplace will be your defense when they tell you they didn’t get your documents.

Mail to:

Health Insurance Marketplace
Dept. of Health & Human Services
Documentation Verification
465 Industrial Blvd.
London, KY 40750-0001

HAVE THERE BEEN ANY PROBLEMS WITH MARKETPLACE APPLICATIONS?

An industry source reported that the Marketplace had 2.6 million consumers that were sent over to a case worker to resolve an issue. The Marketplace case worker has 30 days to look at an issue sent to them and there is no possible manner for a consumer to contact a case worker with questions. Of the 2.6 million cases, 2.1 million remain unresolved. That’s an anemic 19% success rate! You and I would not accept that. My success rate with Marketplace problems is well over 95% and I am dissatisfied that it is not 100%.

IF I CAN’T GET A SPECIAL ELECTION, WHEN CAN I GET HEALTH INSURANCE?

The next Open Enrollment Period (OEP) is November 15, 2014 to February 15, 2015. The earliest effective start date of these new plans is January 1st, 2015. If you want a Jan. 1 effective start date, your deadline to enroll is December 15th.

THE MARKETPLACE IS RUNNING SMOOTHER NOW. IS THERE ANY REASON TO USE AN INDEPENDENT AGENT?

Yes, there are many reasons to use an independent health insurance agent. For example:

First of all, the Marketplace still has many hitches and glitches. Recently I was kicked off Healthcare.gov over 30 times in completing one application.

I work with my clients to find out what is important in your family’s health insurance, present the choices, determine the net cost after subsidy, and look after the application process. All at no cost to you! And when you have questions with your policy, you have an advocate to answer questions without being lost on hold. So contact me today, even if you’ve started the Healthcare.gov process yourself.

I welcome you to share this information with your family, friends and coworkers!

Paul Wavrock
About the Author
Paul Wavrock is the founder of Heath Insurance of Florida, a full service Health Insurance brokerage firm, that utilizes several major National and local Insurance providers to assist its clients and their insurance needs.