ORLANDO, Fla. — So far, we all should know that the deadline to get enrolled in the healthcare insurance market place is December 15, but do you know what happens if something unexpected occurs and you miss the timeline, but still need to obtain healthcare coverage on your own?
Here are a few thoughts— Before 2014, you could buy an individual health plan at any time of the year. Right now, except for special circumstances, you can purchase individual coverage only during the period known as open enrollment which as we mentioned, in Florida expires on December 15th. Nonetheless, the Affordable Care Act provides you with important consumer protections, which is still in effect for now.
If you have a “qualifying life event” like the following, you still may be able to join within a 60 day special enrollment period:
- Getting married.
- Having a baby, adopting a child or placing a child for adoption or foster care.
- Becoming a U.S. citizen.
- Leaving incarceration.
- Losing other health coverage due to job loss, divorce, COBRA expiration or aging off a parent’s plan.
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP).
- For people with a marketplace plan already, having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.
- Gaining status as a member of an Indian tribe.
Assuming you are not eligible for Medicaid or CHIP, which are programs for low income families, you also have a few options.
According to an executive order signed by President Donald Trump and the associated regulation changes that HHS finalized in August 2018, individual plan buyers who are unable – or unwilling – to buy Affordable Care Act’s-compliant plans —may now have the option to purchase a short-term insurance plan with an initial duration of nearly a year and renewal options that allow the plan to remain in force for three years. When and where short-term plans are available, however, they allow for next-day effective dates for applicants who are eligible for coverage.
Although many states still have their own regulations, Florida does not have state regulations for short-term plans, so new federal regulations apply in the state. Insurers can offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months. The law also says that a person who has prior continuous coverage (that’s at least as robust as the new coverage) during the 24 previous months is not subject to pre-existing condition exclusions. But it specifically exempts nonrenewable short-term plans with terms of no more than six months.
In other words, if a short-term plan is nonrenewable and lasts no more than six months, the insurer can set its own rules regarding pre-existing conditions. But if the plan is renewable and/or has a term of more than six months, the insurer can only look at up to 24 months of medical history to determine whether pre-existing condition exclusions will apply, and cannot impose pre-existing condition exclusions at all if the person has had continuous creditable coverage during that time.
As of November 2018, United Healthcare (Golden Rule) appeared to be the only one that was limiting short-term plans to six months. At least six other insurers were offering plans with initial terms of up to 12 months, and some were allowing total duration, including renewals, of up to three years. A closer look at plan brochures for some of those insurers indicated that pre-existing condition look back periods of up to five years were being used, so it’s unclear how well insurers are complying with Florida’s rules regarding pre-existing conditions and longer short-term plans.
Other Florida health insurance resources
Florida Consumer Action Network (FCAN)
Florida Kid Care
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