Buying health insurance in Connecticut during Open Enrollment ends in December 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. The Senior Medicare OE period begins on October 15th and ends on December 7th. However, if you reach age 65 at any time throughout the year, a separate OE period may be created if you are Medicare-eligible.
But for every rule, there are always a few (sometimes many) exceptions, and 2018 is not different. Purchasing coverage in January (and afterwards) is possible, and many affordable medical plans are available. We review some of the best options and the circumstances that they will be offered. Although many policies can be purchased throughout the year by persons under age 65, these plans may be medically-underwritten, or also be designed to be supplementary or ancillary coverage to a primary plan.
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 Anthem Blue Cross And Blue Shield 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. Supplement, Advantage, and Part D prescription drug benefits may be available to you, especially if you have signed up for Parts A and B. Note: Aetna, Cigna, UnitedHealthcare, and Healthy CT previously offered private Exchange plans, but withdrew from the Marketplace.
Can I Buy A Policy After December?
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 (Special Enrollment Period) plan, regardless of Open Enrollment dates. You would also be able to receive the federal subsidy (assuming your household income meets eligibility guidelines) and also purchase off-Exchange qualified coverage. Some of the most likely “life changes” 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.
Losing CHIP eligibility.
Losing Medicare eligibility.
Dependent reaching age 26 (on parent’s plan).
Minimum essential benefits were lost.
Just became a US citizen.
Error in previous Open Enrollment process.
No longer incarcerated.
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 $695 per adult and $347.50 per child, or 2.5% of your income (whichever is greater). The maximum penalty is $2,085. Beginning in 2019, this mandate will be discontinued, and there will be no tax imposed on persons that don’t purchase ACA-compliant healthcare coverage. Several other legislative changes are also expected.
It’s also possible that additional policy options will be offered, that exclude previously-required benefits. For example, catastrophic plans that cover major medical expenses (inpatient and outpatient hospital), with limited or no preventative, office visit, and prescription drug benefits, may be very popular for healthy applicants (ages 40-64), with limited household incomes. Expansion of HSA options, and limited-underwriting contracts could also be introduced.
Of course, premiums (see below) are very cheap, which should easily offset the penalty. Temporary coverage can be purchased in multiple increments, with up to 12 months of coverage guaranteed. Many plans require a separate deductible per three or six-month period. Also, policies may not be able to be renewed with the same company more than one time.
UnitedHealthcare offers the most competitive prices for Temporary medical coverage in Connecticut. Several different types of coverage are offered, along with various ancillary benefit riders. Shown below are monthly rates for the “Short Term Medical Value plan on a 35 year-old male residing in Hartford:
$48 – $10,000 Deductible with 40% coinsurance
$59 – $5,000 Deductible with 40% coinsurance
$74 – $2,500 Deductible with 40% coinsurance
$113 – $1,000 Deductible with 40% coinsurance
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 (until 2019) 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 office visit usage (perhaps 2-4 times per year), and surgeries, and hospital confinements typically result in large out-of-pocket expenses. Physical and mental therapy may not be covered, and maternity is likely to be excluded. Also, non-generic prescription coverage is typically minimal. Unless you miss the OE deadline, these types of plans should not be purchased.
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.