If you've been putting off shopping for health insurance for 2014, beware that you'll miss your chance if you wait too long. Open enrollment -- the time when you can purchase an individual or individual family health plan for this year -- will end March 31. This open enrollment period does not apply to people who buy their health insurance through work; your employer will still hold its own open enrollment period, usually in the fall. For those seeking individual plans, if you haven't bought a health plan by end of the day on March 31, then you'll have to wait until the next open enrollment period, unless you have a special circumstance, such as losing coverage at work or having a baby, and qualify for "special enrollment." The open enrollment for 2015 health plans is set to run from Nov. 15, 2014, through Jan. 15, 2015. You can enroll in Medicaid or the Children's Health Insurance Program, state and federal insurance programs for low-income families, at any time during the year -- but only if your income is low enough to qualify. Although a limited open enrollment period is customary for people covered by Medicare and for employees enrolling in health plans at work, it's a new concept for the individual health insurance market.
A new way of doing thingsBefore this year, you could shop for an individual health plan at any time. But starting with 2014 health plans you're limited to purchasing coverage during the open enrollment period, which began Oct. 1, 2013. "We caution consumers that it may take a while to get through the enrollment process, so they should start it as soon as they can," says Cheryl Fish-Parcham, deputy director of health policy at Families USA, a health care advocacy group. Through March 31, you can buy a health plan directly from an insurance company, health insurance agent, insurance website or through the government-run marketplace in your state. If you qualify for tax credits or cost-saving subsidies to make coverage more affordable, you must enroll through the government-run marketplace to get them.
Health policy experts expect a rush to buy coverage as the open enrollment deadline nears, much as there was a surge at the end of December to buy coverage to begin Jan. 1."As there is tremendous media attention on that date, we'll see a similar phenomenon in March," says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund, a foundation that supports an improved health care system. A Commonwealth Fund survey conducted in December 2013 found that 59 percent of people potentially eligible for coverage who had not yet enrolled in health insurance said they were likely to try to enroll in a plan or find out if they were eligible for financial help by the end of March.
What's the deal with open enrollment?It's no coincidence that an open enrollment period was introduced as part of the Affordable Care Act. Starting this year, individual health plans must cover a set of standard benefits, and insurers cannot deny coverage or charge higher premiums for people with health conditions. The Affordable Care Act also requires almost everyone to have insurance this year. A time period for enrollment was set to prevent people from waiting until they got sick to buy coverage, Collins says. Health insurers need a large pool of people -- not just those with illnesses - to buy coverage in order to spread risk and keep premiums low. If you miss the March 31 deadline to purchase coverage for 2014, you could get another chance to enroll if you have a special circumstance, known as a "qualifying life event." In most cases you have 60 days after the event to enroll. Those events include:
- Getting married
- Having or adopting a child
- Permanently moving to a new area that offers different health plans
- Losing other health coverage because of job loss, divorce, loss of eligibility for Medicaid or the Children's Health Insurance Program, expiration of COBRA coverage or decertification of a health plan. (A plan is decertified if it no longer meets federal and state standards for health plans.) Losing coverage because you didn't pay the premiums does not qualify you for special enrollment.
- A change in your household that affects eligibility for tax credits or cost-sharing subsidies, if you're already enrolled in a marketplace plan.
This year's open enrollment period was purposely set longer to give the marketplaces, insurers and the public time to come to terms with the new rules.