Buying health insurance in Connecticut during Open Enrollment ends on February 15th if you are using Access Health CT, the state Marketplace. Federal subsidies are based on qualifying household income and the Affordable Care Act (Obamacare mandates that no medical questions can be asked and pre-existing conditions must be covered.
But for every rule, there are always a few (sometimes many) exceptions, and 2015 is no different. Purchasing coverage in February (and afterwards) is possible and many affordable medical plans are available. We’ll review some of the best options and the circumstances they will be offered.
However, it’s important to understand that unless you have an approved exception, you will not be able to purchase on or off-Exchange plans from Aetna, Cigna, UnitedHealthcare, Anthem Blue Cross And Blue Shield, Healthy CT, and ConnectCare. If you become eligible for Medicaid, you can apply at any time. And if you reach age 65, you can apply for Medicaid and also purchase an optional Medigap plan.
Can I Buy A Policy After February 15th?
Yes. There are many perfectly legal (and affordable) ways to obtain healthcare benefits. Some of the most common methods are if you have a “qualifying life event.” This allows you to purchase an SEP plan, regardless of Open Enrollment dates. (Special Enrollment Period) You would also be able to receive the federal subsidy (assuming your household income meets eligibility guidelines). Some of the most likely scenarios are:
Adopting a child
Losing medical benefits because of job loss, divorce, ending of COBRA or sudden ineligibility of Medicaid.
Changing residences to a different coverage area.
Dependent reaching age 26 (on parent’s plan).
Minimum essential benefits were lost.
Error in previous Open Enrollment process.
If any of these situations occur, you are given approximately 60 days to apply and enroll in a qualified plan.
What Is The Cheapest Option If I Miss The Open Enrollment Deadline?
A short-term policy is extremely inexpensive compared to Marketplace plans that are not eligible for a subsidy. However, this type of policy is not compliant with ACA mandates, and therefore you will be subject to a tax penalty of $325 per person or 2% of your income (whichever is greater). Of course, premiums (see below) are very cheap, which should easily offset the penalty. Also, the first $10,000 (for an individual) is not considered when calculating the penalty.
HCC Life Insurance company offers the most competitive prices for Temporary medical coverage in Connecticut. We have listed the monthly rates (below) for a 35 year-old male:
$68 – $7,500 Deductible with 50% coinsurance
$72 – $7,500 Deductible with 20% coinsurance
$76 – $5,000 Deductible with 50% coinsurance
$86 – $2,500 Deductible with 50% coinsurance
$115 – $1,000 Deductible with 50% coinsurance
This particular HCC plan offers a $2 million lifetime cap with prescription, office visit and major medical coverage. It is not a permanent alternative to a Marketplace or off-Exchange plan, but it is a legitimate and reputable option if Open Enrollment is missed.
Are Limited Benefit Plans A Good Idea?
Typically, these types of policies have fairly significant holes in coverage, including limitations on number of days of hospital benefits, outpatient surgery coverage, and limits on surgery reimbursements. Also, many of these plans charge a large application fee. $20 is acceptable but $100 and above is borderline egregious. The ACA penalty also applies to these types of policies, making it a very expensive choice for a policy that you are likely to terminate fairly quickly.
Benefits may include preventive coverage along with a specific dollar amount ($40-$80) to pay for office visits and specialist visits that are symptomatic instead of preventive. There usually is a limitation on usage (perhaps 2-4 times per year).
Gaps From This Type Of Plan
One of the biggest pitfalls of “Limited Benefit” plans is the coverage gap if you are hospitalized (both inpatient and outpatient). There is often a designated dollar amount (per day) that is paid along with a predetermined reimbursement schedule for itemized surgeries. A typical daily cap may be $250 or $500, and limit the duration of benefits to 30 days (or less). This can create enormous medical bills that are substantially higher than a conventional policy would have.
Often the companies that offer these options are not “name” carriers and may have sub-par ratings with the Better Business Bureau (BBB), Moodys and other local rating agencies. The number of unresolved complaints may also be large. Our advice: Beware! However, if there are no other viable alternatives, it may be better than being uninsured.
How Much Is The Extra Tax If I Never Enroll?
Officially, the name of the tax is the “Individual Shared Responsibility Payment.” The penalty (discusses earlier) is $325 per adult and $162.50 per child. However, if 2% of your income is greater than those amounts, you will pay the higher tax. Typically, the 2% will be the amount you pay. It is possible, however, that the alternative penalty of $325 may apply for lower-income households.
This amount will be increasing to 2.5% by 2016, which represents $2,500 of extra taxes for a $100,000 household income. If you are without coverage only part of the year, you will be charged 1/12 of the tax for each month that applies. However, despite paying the tax, you are still not covered.
Enforcement details are still unknown, although deducting amount owed from a tax refund is the first step. Form 1095-A is needed if you received a subsidy the previous calendar year. This form is needed to complete form 8962, which documents the premium tax credit you received. So far, more than half of consumers that received a subsidy, are being asked to pay an additional amount since their income exceeded initial estimates.
Also, a special “clawback” provision applies if you underestimate your income. In 2015, when the process is more settled, more robust enforcement procedures will be in place.
You will be exempted from the fee if you miss less than three months out of the year or if the least expensive available plan costs more than 8% of all of your household income. Also, if you’re not required to file a tax return, you also cannot be penalized, so very low-income households are not in jeopardy of paying the penalty.
Some of the lesser-known and rarely utilized exceptions include incarceration, being part of a legitimate Indiana tribe, and being part of a recognized care-sharing ministry. Hardship, religious conscience and affordability are also exceptions.
Can I Enroll Next Year If I Miss This Year’s Deadline?
Yes you can. OE begins in November, and regardless of whether you are currently covered or not, you can apply for a plan. Eligibility for the federal subsidy will be determined by the number of persons in your household along with the Adjusted Gross Income (AGI). No medical questions will be asked and your conditions will be covered.
You don’t have to go without affordable health insurance in Connecticut if you miss Open Enrollment. We’ll show you how to obtain quality benefits at the lowest available prices.