Ohio Open Enrollment for single and family Obamacare health insurance Exchange plans ends on January 31st, 2016. After that date, you need to purchase a plan through a “Special Enrollment,” (SEP) that allows you to qualify for available federal subsidies and have any pre-existing condition covered without proving insurability. Marketplace plans are available when you enroll using an SEP.
What Is A “Special Enrollment” In Ohio?
This refers to specific situations that allow Buckeye consumers to buy policies outside of the normal period. For about 60 days, all Exchange plans that are offered on the Marketplace will be available, regardless of what time of the year this occurs. ACA tax subsidies apply and there are no extra fees or charges. To take advantage of these “special” situations, you must have a “qualifying life event.”
Your enrollment eligibility is not impacted by your income (unless you are Medicaid-eligible). Thus, if you have a high income that excludes you from receiving a tax subsidy, it will not affect your right to purchase a policy during this special period. Of course, if you apply during the OE period, you can view specific tips and information here. And you won’t need a special exemption.
What Are The Qualifying Events?”
No Longer Eligible For Medicaid – If suddenly (for income reasons), you lose Medicaid eligibility, you can enroll. Remember that Medicaid is different than Medicare. Medicare is for persons that have reached age 65 and are no longer working or are not covered under another plan. Medicaid is a national program that helps lower-income Americans obtain healthcare from conventional companies. Benefits are excellent and you can apply at any time.
In many states, including Ohio, Medicaid expansion has made affordable (sometimes free) coverage available to households with limited income. Although provider networks are smaller than a conventional plan, there are still many doctors, specialists, hospitals and other medical facilities to serve your needs.
Birth of a child – This would refer to the newborn, and not the parents of the child. Premiums should be low because of the young age. If the child is born with any type of medical problem, the cost of treatment will be covered. Adoption is also an approved exception, although the appropriate documentation will be needed. Make sure your pediatrician is a participating network provider.
Divorce – This refers to the ex-spouse that is losing their coverage and does not impact the other ex-spouse’s existing plan. You can choose to duplicate (or closely duplicate) benefits, or pick an entirely different plan option. It’s always advisable to research plans in advance, in case the cost information is needed for reimbursement purposes.
Cancellation Of Current Plan – Many in-force policies are being terminated with an option to convert to a different policy. Often, the conversion option is extremely expensive and has out-of-pocket costs that don’t match your budget. You may instead, compare Exchange plans that are eligible for the full federal subsidy. In most situations, this option will be less expensive than converting to the offered plan.
Notification of termination usually gives you at least 30-60 days to change policies. Your new policy is likely to contain many benefits you did not previously have. The subsidy (assuming you qualify), will help manage any rate increases. Regardless if this occurs before or after the OE period, you can qualify for a federal tax credit.
COBRA expires – If you have exhausted your COBRA benefits (usually for 18 months), you no longer have to select a HIPAA plan. Previously, you faced an exorbitant premium that was often higher than COBRA. But starting in 2014, that ended. Now, it is a covered exception and there are many available plans. Most should be less expensive than COBRA. NOTE: Expiration of 12 months of COBRA is not enough. You must utilize 18 months of benefits.
Marriage – Regardless of age (must be under age 65), this qualifies. Usually, one spouse loses their coverage, especially if the policy is an employer-sponsored group plan. You may have to change carriers and possibly find a new doctor, depending on which company you choose. If you move to another state, you will re-enroll in another plan.
Termination of employment – One of the most common situations is when a job is lost. At least you won’t have to worry about medical issues since coverage is guaranteed. If the number of hours you are working is reduced, and the result is a loss of benefits, this will also qualify. When you you leave your employer, you will receive written notification that will qualify as and SEP exemption.
Retirement – If you are retiring from your employer and have to select your healthcare options, you are eligible. You may have an option to convert your group plan and that should also be considered. If you are offered a policy by a new employer, you forfeit the right to purchase a policy through SEP.
Many employers pay a significant amount of your group retirement policy (as much as 90% or more) based on your years of service. If you retire with more than 30 years of service, you may get an offer too good to refuse.
Move – If you permanently move to a different location which utilizes a different insurer and creates different policy choices, you may select another plan. Keep in mind that your rate could dramatically fluctuate. For instance, a move from Ohio to New Jersey would not put a smile on your face. Conversely, if you move from New Jersey (or New York) to Ohio, you’ll have more spending money! Most Northeastern states tend to be more expensive than other parts of the US.
Error – If during your last enrollment, an error occurred, it’s possible you may be able to earn an exception. You will be asked to provide documentation and possibly details of the date you spoke to the representative. Although the number of errors is decreasing, they still occur. These errors can be wrong information give over the phone, or an email or letter you received.
“Minimum Essential Health” Benefits Were Lost – These are the 10 basic requirements of all Metal Exchange plans. Other than non-payment, lapse or forgetting to enroll, when any of these benefits are lost from your current plan, this exception may qualify. Maternity is expensive, and if it is removed from your policy, you will probably be able to select another plan. The assumption is that your existing policy was compliant before the removal of benefits.
Reach Age 26 – If you have been covered under a parent’s policy, when you reach 26, you’re entitled to your own policy. Of course, you do not have to wait until January to apply for the new plan. Presumably, by age 26 you are filing your own tax return. Therefore, your federal subsidy will be based on your income and not your parent’s income.
Not Eligible For Special Enrollment – Go Short-Term
If you don’t qualify for any of the exceptions listed above, there is a very low-cost policy available to both individuals and families at any time of the year. Referred to as “short-term” coverage, these temporary contracts will provide the cheapest Ohio health insurance coverage you can purchase. Not all companies underwrite the policies, but there are several trusted carriers that can be used.
The Positives – The price. As earlier mentioned, it’s cheap and we’ll show some specific examples below. The simplicity. The 12-page applications have been removed, and replaced by a short form with about 3-5 medical questions. If you haven’t been treated by any of the conditions, and you have not been previously denied for coverage, you will automatically (Well…almost) get approved.
If you need coverage quickly, your wait time will be less than 24 hours and an application can be completed in about 10-25 minutes. You can complete the easy form online, or we can email or fax the application. No physical is required and only limited medical information is needed.
Short Term Plan Pricing
And the cost! It’s very inexpensive. The major companies in this niche are Anthem Blue Cross, UnitedHealthcare, Medical Mutual, IHC Group and HCC Life. Estimated monthly premiums for a 35 year-old male living in the Dayton area are listed below:
$36 – $5,000 Deductible
$34 – $2,500 Deductible
$40 – $1,000 Deductible
(Lower coinsurance will increase premium)
The Negatives – If you have any existing conditions, it’s likely they will not be covered. And although preventive benefits are mandated (required by law) to be covered on healthcare plans, the short-term plan is exempt, so you will have to pay for your own annual physicals, OBGYN visits and mammograms. NOTE: Several plans cover annual physicals after a deductible has been met. Also, a rider may be available to cover limited preventative expenses.
Also, since it is not Affordable Care Act compliant, you may be subject to a 2.5% (household income) tax for not purchasing a Marketplace policy. Although we would prefer this tax is waived, in many situations, the money that is saved, far exceeds the 2.5% penalty.
Short-term policies are not designed to pay for long-term treatment of chronic illnesses and diseases. In addition to expensive therapy that may be limited, expensive non-generic drug use could create some challenging financial situations. Other benefits, such as maternity and chiropractor visits are often not covered either.
Regardless of the reasons you missed Ohio Open Enrollment for Obamacare, there are low-cost options that will allow you to quickly purchase coverage and get covered. We’re here to help.
Ohio Medicare Open Enrollment
For Seniors in the Buckeye State, the annual OE period is between October 15th and December 7th. This “Annual Election Period (AEP) is the time of the year when you can change your drug prescription benefits along with your Medigap or Supplement plan. No medical questions or underwriting is needed.
You are not required to make any changes to existing coverage, regardless if your premium increased or decreased. However, since contract benefits may be different on your renewal, or other new plans or carriers may now be available, it’s also a good time to compare policies. Your prescription and medical condition needs should always be considered (along with the rate) to ensure your Supplement, Advantage, or Part D drug plan properly covers your conditions.
If you currently are enrolled in Parts A and B, you can choose to switch to a Medicare Advantage (MA) contract, which is administered by a private insurer. You can also switch from one MA plan to another. If you already are covered under an MA contract, you can switch back to original Medicare, although your rates will likely increase.
February 2015 – 2015 Open Enrollment concludes in six days. Applications submitted before that date will receive a March 1 effective date. Without an approved SEP, after February 15th, although many policies will be available from several insurers, they may not necessarily contain all 10 “Essential Benefits” that are required under current legislation.
October 2015 – 2016 pricing for all Marketplace policies will be available on November 1st, although sporadic releases of rates are starting to appear. Although you can retain your current policy, we encourage the review of all new plans, since large rate changes will occur in many areas.