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California health insurance  -  Health Reform Questions  -  penalty for not getting coverage

 

What If I Miss The Open Enrollment Window?
 

 

This is a great question since we've never really had an open enrollment windowon the Individual and Family health insurance market.  With the advent of guaranteed issue, there had to be protections built in so people wouldn't wait till they had health issues to enroll in coverage.  The Open Enrollment window was born.  What if you decide not to enroll during this window?  Your options will be few if any.  Let's investigate.

Don't Miss the Window

Outside of SEP's or Special Enrollment Windows, the open enrollment window is the only time to join an individual family health plan either on or off the Exchange.  If you do not enroll during this time, you will likely have to wait until the next enrollment window which occurs November 15th through December 7th of each year.  This is a huge deal.  What if you decide not to take coverage during the window and it's now May.  You find out that you need to surgery or have a serious accident.  You will most likely not be able to come on to the health plan until November 15th.  This is akin to going without health insurance today since you may be on the hook for 10's of thousands in health care claims and you may not have full access to providers since you will not have insurance at the time of care.  What are the Special Enrollment Periods or SEP's.

SEP's offer additional opportunities to enroll in health plans outside or Open Enrollment

SEP's are available for people to enroll in a health plan based on certain qualified events.    These events are very comparable to Group events for off-anniversary enrollment.  Here's a list of the common SEP's:

  • Adoption

  • Birth of a family member

  • Death of a family member

  • Divorced

  • Incarceration status change

  • Initial Application

  • Lost job

  • Married

  • Moved in to the State

  • New hire

  • Open Enrollment

Make sure to enroll as soon as your eligible under the SEP as there will be a limited period of time to take advantage of this window depending on the SEP in question. 

Are there any options if you do not enroll during the window?

California will be tricky here.  In other states, we might recommend short term coverage available or even critical illness policies to tie us over till the next renewal window.  Many of the major carriers pulled their short term plan options from the market since ACA was passed so we'll have to evaluate the available options when we get there.  Please contact us if you find yourself in this situation.  Cobra coverage should remain intact and it may provide a longer window to enroll.  The key take-away is that you don't want to exhaust Cobra or any other available option until you have confirmation of enrollment in one of the new plans.

 

You can run your Covered California plan quote during Special Enrollment  to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!

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