Obamacare Open Enrollment is ending soon. If you have preexisting conditions you need to understand the new rules.

The next available effective date for individual major medical health insurance policies purchased on or off the “Health Insurance Exchange” is May 1, 2014.  The last date to buy that coverage is March 31, 2014. After March 31, 2014 you will not be able to purchase individual major medical health insurance on or off the exchange until the next “open enrollment” period begins again on 11/15/2014 and lasts until 2/15/2015. So, if you have a preexisting condition you need to start familiarizing yourself with how open enrollment works now, not later nowAlso, due to a new rule issued by CMS on December 19th 2013 (which expanded the original hardship exemption) the 6.3 million American policy holders who have lost their health insurance because of Obamacare will not be subject to a fine (TAX) in the year 2014 for not buying health insurance.

The old rules are gone

The old rules pertaining to purchasing health insurance in the individual major medical market are now gone. You can no longer purchase individual major medical health insurance coverage whenever you want, all year long. There are now specific time periods where this kind of coverage will be available in 2014 and in subsequent years. Those periods are called open enrollment periods. Outside of those open enrollment periods individual major medical health insurance coverage will not be available for sale. This means that you will not be able to get coverage for preexisting conditions.

This is why it is essential that you understand the new rules for they will affect you and everyone you know who has a preexisting condition or has lost their health insurance because of Obamacare. This is especially true because our existing state run high risk health insurance pools which provided guaranteed issue coverage for those who were declined health insurance coverage for decades before Obamacare are now being dissolved.

Buying insurance on and off the Obamacare exchange

It is important to know that you do not have to purchase health insurance at Healthcare.gov. All products sold on and off the new Obamacare HIX – “Health Insurance Exchange Marketplace” will be guaranteed issue products during the two national Open Enrollment periods. They are:

Open Enrollment Period One: 1/1/14 – 3/31/14

Open Enrollment Period Two: 11/15/14 – 2/15/15

This means that you can not be denied coverage and no exclusion riders can be placed on your policy whether you buy the product on or off the Obamacare HIX but only during these two time periods. After these two open enrollment periods you can be denied coverage. In fact, individual major medical products will not be offered between these two national open enrollment periods. If insurance carriers continued to offer guaranteed issue coverage all year long it would lead to adverse selection, as it did in Massachusetts.

What you need to know right now

Since time is of the essence (and their is nothing timely about purchasing health insurance on the exchange). You need to know the only reason to purchase health insurance inside the HIX – Health Insurance Exchange Marketplace (Healthcare.gov) is if you qualify for an APTC – Advance Premium Tax Credit – (subsidy) to artificially lower the high cost of the Obamacare “Medal” plans – Bronze, Silver, Gold and Platinum. In order to qualify for an APTX your 2014 total household MAGI – Modified Adjusted Gross Income – income after deductions and retirement contributions must be less than:

$46,960 for an individual
$62,040 for a couple
$78,120 for a family of three
$94,200 for a family of four
$110,280 for a family of five
$126,360 for a family of six

If your income is more than the aforementioned amounts, you should purchase your health insurance outside of the HIX. The same plans are available off the exchange and the application process is much faster and far more secure. Again, all major medical health insurance products purchased inside and outside the HIX will be guarantee issue (no preexisting conditions) during the two national Open Enrollment periods in 2014.

If you live in Illinois, the best priced 2014 ‘Medal’ plans are insured and underwritten by Blue Cross Blue Shield of Illinois a Division of Health Care Services Corporation. Find the right health insurance plan for you by exploring all of the plan options, save plans that fit your needs in your Shopping Cart and return to apply for coverage when you are ready. Click their logo to begin.


To shop for all plans on and off the Obamacare HIX in all 50 states click the banner below:


A cheaper option for those without preexisting conditions

If you do not have any serious preexisting conditions, you can save a lot of money if you purchase a non-renewable Temporary health insurance policy for a period of one year. These health insurance policies do not cover preexisting conditions nor do they include all of the federally mandated “Essential Health Benefits” such as Maternity, Drug Rehab coverage and Pediatric Dental. This also means that they are not considered ‘Qualified Health Plans’ meaning that you will be subject to the 1% of your MAGI penalty in 2014 if you purchase one of these plans. That stated the premium difference between these plans and ‘Qualified Health Plans’ is significant. The price difference far outweighs the additional fine you would pay to the IRS in most cases.

To run quotes for a Temporary health insurance plan off the exchange click the banner below:

If that Temporary insurance quote engine does not work in your state click the banner below:


Very Important Note: Since the PPACA mandates that all health insurance policies cover preexisting conditions during the first national Open Enrollment period from 1/1/14 – 3/31/14 and the second national open enrollment period from 11/15/14 – 02/15/15. You can now safely purchase Temporary health insurance knowing that when your one year Temporary policy ends you will qualify by federal law for any ‘Qualified Health Plan’ regardless of preexisting conditions during the second annual open enrollment period in 2014. Outside of those two aforementioned open enrollment periods you will not be able to obtain coverage for a preexisting condition. For this reason you must not purchase the 6 month Temporary health insurance option.

Only the 12 month Temporary insurance option is acceptable at this juncture. If you purchase a 6 month Temporary policy your coverage will end in between the two aforementioned open enrollment periods and you will not be able to obtain another policy that will cover a preexisting condition that you may develop during the first 6 months of Temporary policy ownership. HHS may yet provide us with further guidance as to whether or not the loss of a Temporary health plan outside of open enrollment periods will qualify as a “Special Enrollment” period in 2014 so that one could obtain a “Qualified Health Plan” on a guaranteed issue basis outside of open enrollment periods. As of the date of this writing no such guidance has been received.

What if your plan renews and you lose it in 2014 outside of open enrollment?

If your individual health plan renews in 2014 or you lose that plan  in a month that is outside of the two national open enrollment periods (which would be between 4/1/14 and 11/15/14) that will also be considered a Special Enrollment period. So, you will be able to buy another individual major medical policy on a guaranteed issue basis (no preexisting conditions) from any carrier offering a QHP – Qualified Health Plan – even though you will be at that juncture outside of open enrollment. 



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13 responses to “Obamacare Open Enrollment is ending soon. If you have preexisting conditions you need to understand the new rules.

  1. Please understand most of us myself included are not going to support ObamaCare. I will be repealed in due season. And medical lawsuits will finally be dealt with finally at the expense of so-called progressive lawyers who support the Democratic party. Please do not support this lawlessness against the American people. Thanks!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    • Americansquire,

      If you have spent any time on this blog, you know that I am not a supporter of the law. That stated, it is essential that people who are sick and do not have access to employer sponsored health insurance understand that time is running out for them to purchase their own health insurance. Once we get past April 15th those who have not purchased health insurance OFF or on the exchange during the first Open Enrollment period and do not have access to employer sponsored health insurance WILL NOT BE ABLE to purchase major medical health insurance from ANY carrier until the next Open Enrollment period which begins in November. Equally important to know is that NO ONE has to purchase health insurance inside the Obamacare exchanges. You can get excellent coverage without ever going anywhere near the DISASTER that is Healthcare.gov. Very few people understand this yet. The reason I write and speak so much is to help people understand that until Obamacare is repealed (God willing) the laws have changed dramatically and if you are not informed and need coverage outside of Open Enrollment you will not be able to get it and being sick without health insurance is not a situation anyone wants to experience.

  2. (IT) will be repealed in due season. 🙂

  3. Pingback: Breaking news! Renewal of an individual plan from the old market is a qualifying event with Assurant Health. | C. Steven Tucker.WordPress.com

  4. Cynthia Croom

    Does this mean that, if your employer based plan open enrollment period does not coincide with the Obamacare enrollment period, you have no option but to pay for the employer based plan, or go uninsured between the enrollment periods? Specifically, I would like to take my child off the very expensive group employer plan during my employer’s open enrollment period, but if this is in May, will I have to drop that insurance and wait until November to purchase an individual policy for my son, resulting in his being uninsured from July – January?! This is insanity!!!

    • Cynthia,

      No, thankfully. The loss of employer sponsored GROUP health insurance coverage is a ‘qualifying life event’. Meaning that your son will qualify for a ‘special enrollment’ period. He will not have to wait until January. He can purchase guaranteed issue coverage (no preexisting conditions) from the carrier of his choice on or OFF the exchange all throughout the year. He will not have to wait until the next open enrollment period for the INDIVIDUAL health insurance market.

  5. Connie

    A divorce forced me to get an individual policy, and I was shocked when I was denied coverage by BCBS (the company we used before the divorce) because of a tiny heart murmur that cardiologists have always labeled as not a problem (since childhood, I have periodically seen a cardiologist just to make sure everything is good, and it always has been, but now I see being pro-active is nothing but a red flag to insurance companies). My last cardiologist wrote a letter to BCBS because their reasoning was ridiculous, but we got no where. I finally got insurance with Golden Rule, but they added a rider about the heart. When the next enrollment period begins in November 2014, should I be able to get an individual policy with no rider? Could I get it from Golden Rule? Will having coverage when the enrollment begins work against me? I am 55 with no medical issues, take no medications, exercise regularly, am not overweight, and have never been a drinker/smoker/drug user. Knowing the rider is there is frustrating, as I fear something could happen, the insurance company will connect it to my heart some how and deny coverage. I want to be ready for the new enrollment period and will be looking at companies outside of the exchange. Thank you for your help.

  6. Connie

    Thank you! I went to the quoting engine, but I need to do that again after November 15, 2014, when I can actually change my insurance to get rid of the rider, correct?

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