Buying Health Insurance in Virginia, Maryland, or DC

The Affordable Care Act (ACA) has made it mandatory for most Americans to have health insurance.

In addition to making health insurance mandatory, the new law also makes health insurance guaranteed issue.  This means you cannot be denied coverage for any reason — even if you have a pre-existing medical condition.

If you live in Virginia, Maryland, or the District of Columbia, Virginia Medical Plans can help you get the coverage you need — and avoid a penalty for being uninsured.

Open Enrollment for Health Insurance

During certain times of the year, anyone can buy coverage, for any reason. This time is known as open enrollment:

• For plans effective in 2015: Nov 15, 2014 through Feb 15, 2015 (now closed)
• For plans effective in 2016: Nov 1, 2015 through Jan 31, 2016

Buying Coverage Outside of Open Enrollment

What if you need coverage outside the dates of open enrollment?

Certain life events are considered qualifying events and trigger a special enrollment period during which you may buy a plan.

What are Qualifying Events?

Examples of qualifying events:

• Change in marital status (marriage/divorce/death of a spouse)

• Relocation to a new state or to an area of your current state where the plans offered are different

• Change in family size (birth/adoption/death of a child)

• Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)

• Certain changes in income

• Expiration of COBRA benefits

• A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs.

• An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.

• A court order requiring you to provide health insurance (for example during divorce proceedings).

• Termination of your pre-Affordable Care Act plan outside open enrollment.

What Should You Do if You Have a Qualifying Event?

If you have a qualifying event, you must submit proof of the event and the date it occurred in order to purchase a new plan. Without proof, most carriers will not process your application.

You have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.

Contact us right away so we can direct you to your best option.

If you have a qualifying event and are eligible for a subsidy (click here to find out), then you need to purchase coverage on your state’s health insurance exchange (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Innovation Health/Aetna

Whether you buy coverage directly from the carrier or on your state’s exchange, a quick call to our office at 703-702-8270 will allow us to help you understand your options and choose the plan that makes the most sense for your health needs and your budget.

Short-Term Health Insurance

Without a qualifying event, you can purchase a short-term health plan outside of open enrollment. These plans provide limited coverage, so please be sure you understand what you’re buying.

Contact Virginia Medical Plans

Call us today at 703-707-8270 and we will walk you through your options.

What is a Qualifying Event and What Should I Do if I Have One?

Note: this post was originally published on May 12, 2014 but has been updated for 2015.

When it comes to health insurance, a qualifying event is a life event that makes you eligible to purchase health insurance outside the dates of open enrollment.  A qualifying event triggers a special enrollment period lasting 30-60 days, depending on the event.  Read more about special enrollment periods.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)

• Relocation to a new state or to an area of your current state where the plans offered are different

• Change in family size (birth/adoption/death of a child)

• Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)

• Certain changes in income

• Expiration of COBRA benefits

Newly added by the Department of Health and Human Services (HHS) and effective April, 2015:

• A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs. You could switch, for example, from single to family coverage during a special enrollment period. HHS is not mandating this change until 2017, but is encouraging exchanges to offer it as soon as possible.

• An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.

• If a court order requires someone to provide health insurance (for example during divorce proceedings), the coverage must be available the first day the court order takes effect, even if that date is outside open enrollment.

• If you have a pre-Affordable Care Act plan which does not run on a calendar year basis, and that coverage terminates outside the dates of open enrollment.

What Should You Do if You Have a Qualifying Event?

If you do have a qualifying event, you must have proof of the event in order to be eligible to purchase a new plan.  When applying for coverage, you will need to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.

If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you will need to purchase coverage on your state’s health insurance exchange (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

But remember, you have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.

Give our office a call at 703-707-8270 and we’d be glad to help.

Buying 2015 Health Insurance Outside of Open Enrollment

A qualifying event opens the door to purchase coverage outside of open enrollment.

Open enrollment for 2015 health insurance has ended.  It ran from November 15, 2014 through February 15, 2015.

Outside those dates, you must have a qualifying event in order to be eligible to purchase Affordable Care Act-compliant coverage which is effective in 2015.

NOTE: Anthem has extended its deadline to purchase off-exchange 2015 coverage until February 28.  Click here for more info.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)
• Relocation to a new state
• Change in family size (birth/adoption/death of a child)
• Loss of minimum essential health coverage (change in employment status, cancellation of current coverage)
• Certain changes in income
• Expiration of COBRA

Qualifying Events Trigger a Special Enrollment Period

A qualifying event triggers a special enrollment period during which you can enroll in a health insurance plan outside of open enrollment.

Most special enrollment periods last 60 days, so be sure to act quickly if you have one of these events.

If You Have a Qualifying Event

If you do have a qualifying event, you must have proof of the event.  When applying for coverage, you will be asked to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.

If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you must purchase coverage on your state’s health insurance exchange in order to collect the subsidy (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

What if You Don’t Have a Qualifying Event?

Absent a qualifying event, most individuals will not be able to purchase Affordable Care Act (ACA)-compliant health insurance coverage for 2015 after February 15*.  Instead, you will need to wait until next year’s open enrollment to buy coverage effective in 2016.

If you are concerned about being uninsured for the remainder of 2015, you may have an option to purchase a temporary policy as a bridge through the end of the year.

Temporary plans offered outside of a special or open enrollment period will not be ACA-compliant.  One critical missing piece will be coverage for pre-existing conditions; they will not be covered.  But you would be covered for any new illness or injury that arises.  Although not ideal, a temporary plan is better than having no coverage at all.

Here are two companies we work with that offer short term, temporary coverage:

• Assurant Health
• UnitedHealth Care

Virginia Medical Plans Can Help

If you have a qualifying event, let us know right away so we can help you find new coverage that will best meet your needs.

Even without a qualifying event, if you do not have health insurance, give us a call.  We may be able to help you at least find a temporary policy to give you peace of mind until 2016.

Give us a call at 703-707-8270.

*Exception — Anthem BC/BS has extended its deadline to purchase off-exchange 2015 plans to February 28, 2015.  Click here for more information.

How Long is My Health Insurance Coverage Effective?

In general, health insurance policies are effective for 12 months, and the period during which coverage is provided is called the plan’s benefit year.

For individual health insurance policies — whether purchased on or off the exchange — the benefit year runs on a calendar basis, from January 1 – December 31.

However, not all policies will be effective for the full 12 months.  This is because the start date of an individual policy could be later than January 1 for one of two reasons:

• Open enrollment extends past January 1.  For example, open enrollment for 2014 plans ran through March 31, 2014, meaning consumers could enroll several months beyond Jan 1. The same will be true in 2015 and subsequent years, when open enrollment is scheduled to run through February 15.
• Special enrollment periods are available throughout the year, meaning consumers may enroll in a new policy whenever they have a qualifying event.

Regardless of a plan’s start date, however, the benefit year for all non-group plans ends on December 31 and a new benefit year begins on January 1. This means the cost-sharing features of a plan (e.g., deductibles, out-of-pocket limits, etc.) start over each January 1.

January 1 is also the date when premium rates on a non-group policy can change.

What Will Happen on December 31?

Your health insurance carrier will most likely give you the option to automatically re-enroll in coverage at the end of your benefit year.

But since premiums and plans can change from year to year, it will be important to carefully compare your options for next year’s coverage.

Open enrollment for 2015 health insurance begins on November 15, 2014 and runs through February 15, 2015.  During these dates, you can switch to a new 2015 individual or family plan for any reason.  Your new coverage effective date will be determined based upon the date you enroll.  Click here to learn more.

Help Choosing the Right Health Insurance

Virginia Medical Plans is available to help you make the transition from 2014 to 2015 health insurance coverage.  Contact our office as open enrollment approaches so we can help you choose the right plan to meet your specific needs.

Reach us by phone 1-800-867-0800 or email jkatz@vamedicalplans.com.