ACA Update: Satisfaction Guaranteed?

By Emily McKinley, Health Information Specialist

We have entered the final month of Marketplace open enrollment, and soon the ACA application fury should be winding down. At least, we hope the glitches will be fixed and consumers will have active insurance giving everyone a bit of a breather from this hectic and, well, less than ideal enrollment period. So, before open enrollment ends, here are a final few tips and reminders.

Open enrollment ends March 31. To guarantee coverage effective April 1, you must enroll prior to March 15. As a tip, if you do miss this deadline, try calling the insurer directly, requesting an April 1 active date, and pay your premium before then. The insurance company may be able to work with you but is not required to do so (and, may, in fact, be held hostage to the processes of the Marketplace).

For those who have experienced technical difficulties and delays with regard to determining eligibility, a new bulletin released by HHS states that you may be eligible for retroactive coverage. Additionally, those who purchased a qualified health plan (QHP) outside the marketplace while waiting for an eligibility determination may be eligible for retroactive premium tax credits and cost sharing reductions. Further, they will be allowed an extended enrollment period and an option to change plans once the eligibility determinations have been made.

If you miss open enrollment for other reasons, the only way to enroll in a new plan during the year is if you experience a qualifying life event, such as the addition of a family member (birth, marriage, etc.), the loss of employer-sponsored coverage, an interstate move, or a change in income that may affect coverage and/or tax credit and subsidy amounts. Please note, if you are currently insured through a COBRA policy and wish to switch to a Marketplace plan, you must do so during the open enrollment period. Otherwise, you will have to maintain COBRA coverage until the policy period ends (typically 18 months after employment was terminated) or wait until the next open enrollment period.

The ACA does allow consumers one, three-month uninsured “grace” period each year without tax penalty. Individuals who remain uninsured for a longer period of time will incur tax penalties. Further, the consumer is assuming the risk of and responsibility for any health care related expenses during that period.

Additionally, insurers must extend a three-month grace period to all insured consumers who have paid at least one month’s premium and who qualify for premium tax credits and/or cost sharing reductions. After that period, coverage may be terminated. To continue coverage, the consumer must pay all outstanding premiums.

Is there recourse for individuals who have purchased unsatisfactory or misrepresented plans? Yes and no. Consumers do not have many options when it comes to changing plans once the coverage is effective. That said, The Washington Post recently reported that a memo from federal health officials to insurers states that consumers may change plans if they change to another plan offered by the same company. For more information about that memo, read the article here. We also encourage working in tandem with the Marketplace and insurance companies to resolve complaints, as a consumer may escalate a complaint from both sides. Further, consumers may also file complaints with the Indiana Department of Insurance. For more information, see the IDOI website.

As open enrollment closes and this period of change comes to a rest, we are hopeful that consumers will find themselves with satisfactory coverage and worries will abate. As such, the ACA Update may also wind down, responding only to updates and consumer concerns rather than as a feature on a monthly basis. Please let us know your questions, concerns, and experiences so we may address the issues pertinent to our audience.

As always, if you have questions regarding the topics presented in this update or regarding your family’s experience navigating systems of care, please contact us at info@fvindiana.org or 317.944.8982. We also encourage you to visit our website, www.fvindiana.org, for information on a variety of topics.