The 2015 Open Enrollment Period to buy health insurance under the Affordable Care Act, sometimes called “Obamacare,” ended February 15 for many insurance marketplaces, including the federal Health Insurance Marketplace (healthcare.gov).
For most people who carry their own individual or family insurance, that means you can’t buy a qualifying health insurance plan again until later this year, when the 2016 Open Enrollment starts (October 2015).
However, certain “qualifying life events” can make you eligible to buy or change insurance earlier, during a “Special Enrollment Period” before that next Open Enrollment Period. Some common events that can trigger a Special Enrollment Period include:
In general, your Special Enrollment Period ends 60 days after the qualifying life event if it involves a change in family status (marriage, new baby, etc.) or 120 days if you lost coverage. You can start the application process up to 60 days before an event. So, as soon as you know an event has occurred (or will), it’s good to contact a health insurance provider or healthcare.gov to avoid any lapse in coverage.
Not sure whether you qualify? Or feeling a little daunted by the challenges of navigating the Health Insurance Marketplace and choosing a new plan? As was true during open enrollment, thousands of people in Pennsylvania have been getting expert, one-on-one guidance by visiting a Highmark Direct store.
“Most people have a basic understanding of health care reform and how it works, but there are also areas where special expertise makes the process easier and gives you extra assurance,” says David Homer, a Highmark Inc. product consultant who previously managed the Highmark Direct store in Monroeville, PA.
He cited an example of a woman who had visited his store during his time as a store manager. When she tried to apply for insurance online, the Health Insurance Marketplace said she had to wait until the next Open Enrollment Period.
“If she was at home, that might’ve been the end of the story,” Homer says. “But based on what I’d learned by talking with her, I knew that wasn’t right, so I had her phone the Marketplace Call Center right there in the store. If people authorize us to do so, we can even sit in on a call like that. Sure enough, she got an okay, and then we went right into the application process.”
One qualifying life event that is sometimes overlooked is a change in taxable income — which Homer explains should always be reported. “If your income drops, you want to make sure you get any tax credit or cost-sharing reduction that’s due to you. If you get a raise, your tax credit may decrease — and that might mean you want to choose a different plan.”
Making sure people get the right plan for their situation is central to the Highmark Direct experience. “When people come in, they’re often feeling overwhelmed by the different plan options on the market,” Homer says. “By asking the right questions, we can almost always get focused on the two or three that will be a good fit — and make sure no one signs up for coverage that they’ll feel bad about later. The stores are really here to help you make the right decisions for you and your family.”
Homer says that health insurance expertise is only part of the Highmark Direct equation. The stores are also specifically designed to provide a very personal, non-pressuring environment. “In hiring, Highmark Direct looks carefully at a person’s experience and skill in one-on-one interactions,” he says. “There is thorough training to give them the knowledge they need, but they have to be exceptionally customer-focused, caring and friendly, and good at building relationships — that’s what the stores are all about.”
Homer emphasizes that the value of the stores is not limited to shopping for health insurance. The stores regularly host events where people can learn about how to use their health insurance, meet with wellness and nutrition coaches, and much more.
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