Open enrollment for the new health insurance exchanges (AKA marketplaces) begins October 1. Are you ready?
No matter what you’ve heard, read or seen about healthcare reform, the only thing you need to know is this:
The healthcare reform timeline drives the entire process. You could say the devil is in the dates. You need to know the timeline so you don’t make a fatal mistake.
That’s right, dates determine eligibility and enrollment and if you screw up a date because you “didn’t know,” tough luck. The government is not going to be very forgiving. (Are they ever?)
So, in order to help you make sense out of it all, I’ve compiled a healthcare reform timeline for the individual exchange for 2013-2014. Some dates may be familiar, but I guarantee some will be a total surprise. And an unwelcome one at that. Don’t risk making a mistake!
The Initial Open Enrollment Period is October 1, 2013-March 31, 2014
The government has been touting that open enrollment would begin October 1. Not a big surprise. But lasting through March 31? Yep- I was surprised to read this too. So if you’re being pressured that “you must make a decision” before January 1, relax. And unscrupulous salespeople will use this tactic, so consider yourself warned. In fact, be glad you have some extra time. I think with all the delays, we’ll be lucky to see the exchanges start October 1 as promised.
Once the Initial Open Enrollment is Past, It’s Too Late
Once the initial open enrollment is past, you are locked out of enrolling in an exchange plan. You heard correctly- you will not be able to sign up.
So, if you decide you just don’t want health insurance in February, but change your mind in April, tough luck. You could purchase off the exchange, but there will be no financial aid available. So you get to pay the whole premium. And remember this: the ONLY reason you would want to get a plan through the exchange is to get assistance with your premium or your out-of-pocket costs. So if this assistance is important to you, I suggest you keep reading……
Exception: there are a handful of situations that prompt a “special enrollment period” (SEP) where you can enroll in an exchange plan. Examples include:
- Gaining or becoming a dependent
- Gaining status as a citizen, national, or lawfully present individual
- Loss of minimum essential coverage (e.g., loss of Medicaid eligibility, termination of a QHP), except if enrollment is terminated based on failure to pay premiums
- Loss of affordable employer-sponsored coverage
- Determination that an individual is newly eligible or ineligible for premium tax credits or a change in eligibility for cost-sharing reductions
- Permanent move to an area where different QHPs are available
- Other exceptional circumstances identified by the Marketplace
Note: QHP means Qualifying Health Plan, a name that simply means a health insurance plan that has passed acceptability standards for selling in the exchange.
In most cases, SEPs will extend for 60 days from the date of the triggering event. Under certain circumstances, such as the pending loss of minimum essential coverage due to the termination of a QHP, an SEP may begin before the triggering event takes place.
Effective Dates During Initial Open Enrollment Period
Your effective date is decided solely on when the enrollment application is received. The following chart is a good illustration.
If You Miss the Initial Open Enrollment Period and Don’t Qualify for a Special Enrollment Period
You must wait until the Annual Enrollment Period, which will begin October 15, 2014 and ends December 7, 2014. Just like the initial open enrollment period, the date the enrollment application is received determines the effective date.
Health insurance has always been a specialty at my agency, Alan Galvez Insurance. When healthcare reform came around, we decided we weren’t going to abandon the industry. So, I just completed my training and certification to sell in the Ohio exchange. Yep- I’m 100% official. Product reveals won’t come for a few weeks, but know this- I’m ready for you when the exchanges are. Feel free to contact me to see if I can help you.
Does this information help you recognize the importance of understanding the healthcare reform timeline? Any other questions you have?
For more information, you can also reference two additional posts about Obamacare Basics- Obamacare Basics Part 1-What It Means For You and Obamacare Basics Part 2: Individual Health Insurance Options.