I missed the ACA enrollment deadline… Now what?
OOIDA’s Medical Benefits Group offers help, suggestions

By Greg Grisolano, staff writer

Thought March 31 was your last chance to sign up for insurance through the Affordable Care Act? Well, not exactly…

Although the deadline for the open enrollment period is over for most people, there are still some options for getting insurance coverage, according to insurance experts.

“You still do have options,” said Rick Welsh, president of Welsh and Associates, a Kansas City-based health care and insurance consulting business that works with OOIDA’s Medical Benefits Group. “You can get some sort of protection on a temporary policy to fill in the gap until Jan. 1 (2015).”

Now that the open enrollment deadline has expired, you can purchase an ACA-compliant plan only by having a qualifying event, such as loss of job, marriage, divorce or birth. You can also qualify by moving from one state to another.

Welsh said the benefit of a temporary insurance policy is it will help cover any medical costs between now and the start of 2015. But he said the plans “will not keep you out of the penalty box” come tax time.

“These temporary policies are not ACA-compliant, meaning they don’t have all the bells and whistles, the preventive care,” he said. “Major medical policies have one gatekeeper underwriting thing. Any major conditions in the last five years mean you’re not (going to get coverage).”

Welsh said some of the major medical conditions that would likely disqualify an applicant for temporary coverage include heart attack, stroke or cancer.

Another option is OOIDA’s scheduled benefits plans, which are not major medical coverage but do pay a portion of medical expenses. The scheduled benefits plans have no underwriting questions.

“The only way you can get into (an ACA-qualified plan) now is by having a qualifying event,” said Brenda Smith, director of OOIDA’s Medical Benefits Group. “We can offer short-term policies and supplements. What (members) need to do is call here and let us explain it to them. We might be able to combine (policies) with critical illness or scheduled benefit plans.”

Smith said residents in at least one state, Nevada, are able to enroll in insurance year-round, because of the way the state set up its insurance exchange. She also said members need to be preparing in advance for the next open enrollment date on Nov. 15, 2014.

“If you’re not going to do anything at all, be prepared for the next enrollment,” she said. “Do not wait until the last minute.”

By the end of the open enrollment period, President Obama announced that enrollment reached 7.2 million, although that figure includes only the number of individuals who have signed up for coverage, and not the number who have paid for it yet.

In March, The White House announced two additional deadline extensions.

The first extension allows people with health insurance plans that don’t comply with Affordable Care Act standards to keep them through October 2017 if their states allow it. The second extension extends the open enrollment period for next year to Feb. 15, 2015.

If you are not already enrolled in a public or private health care plan or do not have health insurance through an employer-provided plan or are not a U.S. military veteran enrolled in VA healthcare, you must be enrolled in a qualified health care plan by the deadline, or possibly pay a tax penalty.

The temporary policies also do not absolve the tax penalty the IRS will assess to those who by law are required to get insurance. Exemptions from the penalty include:

  • Being uninsured for less than three months of the year.
  • You don’t have to file taxes because your income is too low.
  • Membership in a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
  • The lowest-priced coverage available to you would cost more than 8 percent of your household income.
  • Membership in a federally recognized tribe or eligible for services through an Indian Health Services provider.

There are also a number of “hardship” exemptions, including filing for bankruptcy in the previous six months, or if you were determined ineligible for Medicaid because your state didn’t expand eligibility under the Affordable Care Act. For a complete list of exemptions and more information on how to apply, visit healthcare.gov/exemptions.

The penalty for not having insurance in 2014 is $95 per person ($47.50 per child under 18), or 1 percent of your yearly household income, whichever is greater. Unless your yearly household income is less than $9,500, you can expect to pay much more than $95 in tax penalties. Penalties are scheduled to increase in 2015 and 2016, and will thereafter be indexed to inflation.

The penalty for being without insurance is calculated on a monthly basis. So if you have a qualifying event and get insurance later in the year and are without insurance for only six months, for example, you will owe half of the penalty.

For more information contact OOIDA’s Medical Benefits Group. Agents are available from 7:30 a.m. to 5:30 p.m. Central Time, Monday through Friday, at 800-715-9369 or via e-mail at medben@ooida.com. LL