The last quarter of 2013 was filled with horror stories of millions of Americans – many of them Cancer patients – losing their health insurance because of the PPACA “Obamacare”. Even though Barack Obama promised “if you like your plan you can keep your plan and no one will take it away from you, period.” At the very least, many of the 6.3 million policy holders who had their coverage canceled were able to obtain a QHP – ‘qualified health plan’ – on a guaranteed issue basis (no preexisting conditions) as a replacement shortly thereafter. Albeit those plans are often times more expensive and expose those consumers to higher premiums and out of pocket risk exposure, most especially if they do not qualify for taxpayer funded ‘advance premium tax credits’- to artificially lower premiums and ‘cost sharing’ subsidies to lower deductibles.
That was then, this is now.
The new wave of Obamacare horror stories will begin being told all across America now that we are outside of the first national ‘open enrollment‘ period which ended on 3/31/2014. Only this time it won’t be about Americans losing their health insurance. It will instead be about the vast majority of Americans being unable to purchase individual, renewable health insurance from any carrier no matter how sick they are until January 1, 2015. That’s right, unlike before Obamacare when you could blame those “evil health insurance companies” for “denying you your right to health care.” Now, the blame will rest squarely on the shoulders of the greatest health insurance salesman in world history, Barack Obama.
Millions of Americans are about to be denied their ‘right‘ to health care.
It is Barack Obama’s health care law that will be directly responsible for denying millions of sick Americans their ‘right‘ to health insurance from now until January 1, 2015. From now until then Americans who wish to purchase their own individual, renewable health insurance are barred by federal law from doing so. In fact, the only way to do so now is you have a ‘qualifying life event’ and as such qualify for a ‘special enrollment‘ period. The truth is under Obamacare your ‘right’ to health care refers to beseeching yet another group of nameless, faceless government bureaucrats who may or may not let you purchase health insurance that will cover your preexisting conditions. Yeah, this is going to be great! Forward!
The rest of us in the individual market will be barred by federal law from obtaining our own health insurance that covers preexisting conditions until January 1st, 2015. It is from this pool of millions that the new horror stories will come from. Imagine you are a low information voter who doesn’t vote at the ballot box but votes for American Idol candidates every year. Then, imagine you develop cancer or another life threatening illness in May and find out that you can’t get health insurance coverage that covers your preexisting condition for another 7 months. Yeah, 2014 is going to be a great year politically for Republicans. Not even they can screw this gift up.
Examples of qualifying life events are:
- You move to a new area that offers you different plans, or isn’t covered by your HMO network.
- You get married.
- You get pregnant or adopt a child.
- You lose other health coverage due to job loss, a decrease in work hours, end of COBRA coverage or other reasons.
- You become a U.S. citizen.
- Your income changes, or some other event changes your income or household status.
- You can prove that your health insurance company violated its contract with you.
- You are no longer covered on a family member’s policy because you turned 26, you have legally separated from or divorced your spouse, or the policy holder has passed away.
- You become a member of an Indian tribe. Other complicated cases that may qualify for a special enrollment period
- You faced a serious medical condition or natural disaster that kept you from enrolling. For example:
- An unexpected hospitalization or temporary cognitive disability
- A natural disaster, such as an earthquake, massive flooding, or hurricane
- A planned Marketplace system outage, such as Social Security Administration system outage
Misinformation or misrepresentation Misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, certified application counselor, or agent or broker) resulted in you:
- Not getting enrolled in a plan
- Being enrolled in the wrong plan
- Not getting the premium tax credit or cost-sharing reduction you were eligible for
Enrollment error Your application may have been rejected by the insurance company’s system because of errors in reading the data, or some of the data was missing or inaccurate. System errors related to immigration status An error in the processing of applications or system caused you to get an incorrect immigration eligibility result when you tried to apply for coverage. Display errors on HealthCare.gov Incorrect plan data was displayed at the time that you selected your health plan, such as benefit or cost-sharing information. This includes issues where some consumers were allowed to enroll in plans offered in a different area, or enroll in plans that don’t allow certain categories of family relationships to enroll together. Medicaid/Marketplace transfers
- If you applied for Medicaid through your state, or were sent to Medicaid from the Marketplace, but you weren’t eligible for Medicaid.
- Your state transferred your information to the Marketplace but you didn’t get an answer about your eligibility and/or didn’t get enrolled before March 31.
Error messages Your application was stopped due to specific error messages. For example, you received a “data sources down” error message or another error message that didn’t allow you to enroll. Unresolved casework You’re working with a caseworker on an enrollment issue that didn’t get resolved before March 31. Victims of domestic abuse You’re a victim of domestic abuse and weren’t previously allowed to enroll and receive advance payments of the premium tax credit separately from your spouse. You’ll be able to do so now. Other system errors Other system errors that kept you from enrolling, as determined by the Centers for Medicare & Medicaid Services
You can still buy health insurance in the individual market but it won’t cover your preexisting conditions
Nonrenewable ‘short term’ or ‘temporary’ individual health insurance policies are still available for sale but they will not cover your preexisting conditions. And, only a few health insurers are still offering them. Some of the biggest players in the market such as Aetna and Humana are not offering temporary plans. Of the few carriers who still are, I recommend Assurant Health for unlike other carriers Assurant Health covers outpatient prescription drugs the same as any other illness. Other carriers do not. To get quotes for temporary health insurance coverage from Assurant Health click their banner below:
You will owe a non compliance ‘fine’ (TAX) to the IRS for taking the short term route
You must also understand that you will be subject to a 1% of your MAGI ‘fine’ (TAX) for purchasing temporary health insurance since these plans do not include the “essential health benefits” under Obamacare such as Maternity for 62 year old women and single men, drug rehab coverage for those who do not own a crack pipe and pediatric dental for those without children. As such temporary policies are not considered ‘qualified health plans’. Rest assured though, if you are self employed and do not over pay your taxes you will never pay that ‘fine’ (TAX) for the only recourse the IRS has to collect that fine is to hold your tax refund. All criminal penalties for non compliance were removed from the health care law prior to passage.
The other kind of health insurance that covers preexisting conditions outside of open enrollment
The other option if you need coverage for preexisting conditions outside of open ‘enrollment’ is to purchase small group health insurance which is available to groups of two or more people. However, you must be incorporated and take a Schedule K as an owner of the company. Also, if you are already sick the policy will be max rated and with most carriers if you are going to add employees they must be W2 employees not 1099 contractors.
If your pre-2014 individual health plan is renewing that is a ‘qualifying event’ with Assurant
Assurant Health announced yesterday that they are now honoring this regulation that states quite clearly that if you have an ‘old’ policy from the ‘old’ market and that plan renews you can purchase a 2014 ‘qualified’ Bronze, Silver, Gold or Platinum health insurance plan on or off the exchange on a guaranteed issue basis between open enrollment periods. This is VERY good news for anyone who has an ‘old policy’ that renews this year and is facing a large premium increase and/or has exclusion riders on their existing policy and wishes to purchase a new 2014 plan without exclusion riders.
At this juncture, Assurant Health is the only carrier that I am aware of that is honoring the aforementioned regulation and as such they have a corner on the market until the next open enrollment period begins on November 15, 2014 for coverage effective dates beginning no sooner than January 1, 2014. As I stated in this recent article, many health insurance carriers like Aetna and Humana are not even offering short term (temporary) health insurance products until the next open enrollment period and the few carriers who are offer them with dangerously low lifetime maximum coverage amounts. It must also be reiterated that if you purchase short term coverage these policies do not cover preexisting conditions and you will be subject to a 1% of your MAGI ‘fine‘ (TAX) from the IRS if you purchase short term coverage because those plans are not considered ‘qualified health plans‘ under CMS and HHS regulations.
If your old health insurance plan is renewing in 2014 and you wish to get quotes from Assurant Health for a qualified replacement plan click their logo below. There is a now a new section on the application where you will need to either upload a copy of your existing health insurance ID card proving that you have a policy from the old market or you can fax a copy of your old ID card to the fax number provided on the application. This is necessary to prove that you qualify for a special enrollment period as an applicant with a qualifying event.