Window opens for individuals and families to buy or change health plans

The first annual six-week open enrollment period to purchase individual health insurance has begun.

Until August 15, Massachusetts residents who either want to purchase individual or family health insurance coverage or want to switch their existing coverage will be able to do so will be able to do so via the Health Connector, or directly from health plans. After August 15, under a new state law, the window of opportunity shuts.

Until last year, Massachusetts individuals and families could buy or switch their health plans at any time they needed to throughout the year. Concerns about abuse from “jumpers and dumpers” – policyholders switching to more extensive and expensive coverage right before they needed care and then switching back or even dropping that plan after they received treatment – prompted the legislature to enact open enrollment, which is, of course, only “open” during a very limited timeframe.

The law means that unless some individuals or families act within the next six weeks they will either be stuck with the plan they have or, for many of those who are currently uninsured, with no plan whatsoever.

This open enrollment period only applies to residents purchasing insurance for themselves or their families, not to residents who are eligible for employer- or government-subsidized coverage or to self-employed residents.

The open-enrollment period doesn’t apply to everyone though. Certain residents who meet “special conditions” are exempted from the open-enrollment restrictions. You are exempt if you:

  • Used some of your COBRA or mini-COBRA benefits but cancelled them within the last 30 days;

OR

  • Had health insurance coverage for the last 18 months; and
  • Did not experience a break in coverage of more than 62 days; and
  • Do not currently have access to employer-sponsored coverage that meets the state’s Minimum Creditable Coverage standards for being insured and avoiding tax penalties; and
  • Do not currently have access to Medicare, or MassHealth; and
  • Did not lose coverage due to fraud or non-payment; and
  • Are acting within 62 days of one of the following events:
    • Losing employer-sponsored health insurance coverage
    • Running out of COBRA or mini-COBRA benefits
    • Declining an employer’s offer of COBRA or mini-COBRA benefits
    • Losing government-subsidized health benefits such as MassHealth, Commonwealth Care, TRICARE, etc.
    • Losing coverage due to the loss of dependent status through divorce, age-out, death of a spouse, legal separation, or the end of a domestic partnership
    • Moving out of the service area of a health plan
    • Losing coverage under a qualified Student Health Insurance Plan

There is another way to get around the Connector’s open enrollment restrictions. The Department of Public Health’s Office of Patient Protection will consider applications for waivers from people who have been denied insurance coverage because they missed the open enrollment period, depending on the reasons why they missed their opportunity during the open enrollment period. More information about the waiver process is available here.

For more information, residents can jump to the Health Connector’s web site, mahealthconnector.org, call the Connector at (877) MA-ENROLL, or call our HelpLine at 800-272-4232.
-Sam Solomon

About HCFA

The Ultimate Massachusetts Health Care Insider Information
This entry was posted in Private Market. Bookmark the permalink.

2 Responses to Window opens for individuals and families to buy or change health plans

  1. Joe says:

    How about making the obese (who constitute 20 percent of the population) pay a higher premium for their insurance? This will offset their costs to the rest uf us, what with their DM, CAD, hypertension, etc.

    The same can be done for those born with chronic conditions. Those of us who merely go for annual physicals, and who live healthy lifestyles should be able to get insurance at rock-bottom prices, purchasing high deductable policies to satisfy the “Sooner or later you’ll have an AMI” preachers.

    Oh but wait, this would preclude the Massachusetts Liberal philosophy. Nevermind….

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s