20 Mar Insurance Talk — Health Insurance Special Enrollment Periods
Rex and Cheri have the answers. Listen here.
Insurance Talk — Health Insurance Special Enrollment Periods
The COVID-19 pandemic has resulted in lost jobs, lost income and lost health insurance for people in a variety of industries from entertainment to restaurant staff and a variety of other small businesses. We recorded this podcast before the thought of Coronavirus ever entered our minds and in recent weeks it has become important for many individuals in our communities. Listen to our podcast on health insurance Special Enrollment Periods or read the transcript below to learn about if you qualify for health insurance SEPs.
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Health Insurance Special Enrollment Periods
Cheri Martinen – You are listening to Insurance Talk. This is Cheri Martinen and Valerie Best and we’re from Bancorp Insurance located in beautiful Central Oregon. We’re a family-owned, family-run insurance agency helping you with all of your insurance needs, including Medicare and health insurance, which is what we’re talking about today. One of the questions we get now that we are out of open enrollment, which just a reminder, open enrollment is between October 15th and December 7th of every year for a Medicare Advantage and prescription drug plans.
Valerie Best – Don’t forget about individual health care though. That open enrollment period is November 1st through December 15th.
CM – During that fall to the winter season, we’ve got the main open enrollments. But what about the rest of the year? What happens if you move or you have some sort of the change in your health insurance, maybe you change jobs, what do you do then? What is a Health Insurance Special Enrollment Period?
VB – There are some qualifications that are called ‘Special Enrollment Periods.’ One Special Enrollment Period would be when you do move, even if you just move from county-to-county, that can change your options for health care. And that creates what they call a ‘Special Enrollment Period.’ You have the right to look at your health care options from your new address. Changing where you live, even if it’s just county-to-county in Central Oregon, can make a big difference in your health care options. Another option would be if you lose your current coverage. If your employer has decided to drop your coverage, that creates a Special Enrollment Period. If you lose OHP, if you’re currently on the Oregon Health Plan and life has gotten better and you have lost your OHP coverage, that creates a Special Enrollment Period. Generally, Special Enrollment Periods are 60 days. They start the day your existing coverage terminates and you have 60 days to enroll in a new plan.
CM – Can you shop before your plan is gone? Let’s say I know I’m losing my health insurance. Maybe I’m switching jobs or my spouse is switching jobs and we’re losing coverage, but I don’t want to have a gap of 60 days where I don’t have any health insurance. VB – That’s a very good question. Yes, you can shop for health insurance and create an effective date that would be the same day as your current coverage terminates or actually the next day. Coverage terminates at 11:59 PM, the new plan starts at 12:01 AM, the same as with your auto and your home insurance. So yes, you would not have a lapse in coverage.
Specific Special Enrollment Periods
CM – Awesome. That’s good to know. What are some of the other Special Enrollment Periods?
VB – Some of the other options might be if your employer suddenly does offer coverage or the union says, ‘Hey, we’re going to go ahead and offer you coverage now.’ You can enroll in that. When we look at it from the Medicare side, it might be something like veterans. You could enroll in VA or in Tricare prescription drug coverage so that you do not have to have a Medicare prescription drug plan or a Medicare Advantage prescription drug plan. You could just have your VA and that coverage is considered credible by the centers for Medicare and Medicaid.
CM – So there are a lot of Special Enrollment Periods and most of the ones we just went over were for Medicare, but there are also Special Enrollment Periods for, as you said, individuals who are under 65 and might be on the Affordable Care Act. You might have your coverage through them. And like we said, maybe you move, but they have a couple of other life events that qualify for a Special Enrollment Period. VB – Right. If you adopt a child, if you have a child, give birth to a child, birth, death, divorce, marriage, those are all qualifying life events and allow you to have a Special Enrollment Period to review your health care coverage and change if you’d like to if there’s another plan that would be more beneficial.
Affordable Care Act and the Premium Tax Credit
CM – One of the other things we get questions on a lot throughout the year for the individual health insurance, especially through healthcare.gov or Obamacare, as sometimes people call it, is, ‘I just got a raise’ or ‘I switched jobs and now I’m making more money.’ Or maybe you’re going from full-time to part-time due to life changes and so your income’s changing and this is a question we get a lot like, what do I do?
VB – Income changes are important to report to the Affordable Care Act, to healthcare.gov, to the Marketplace, to Bancorp Insurance. Because your premium tax credit, the amount of money that the federal government pays on your behalf to the health plan changes based on your income. It is inversely proportional. The higher your income, the lower the premium tax credit. Inversely proportional the lower your income, the higher the premium tax credit. So you always want to make sure you’re at a level point with that income and what you’ve requested from the Affordable Care Act. If you declare your income higher than it actually is, they may reimburse you some of the premium tax credit. Again, inversely proportional. If you declare your income too low and take too much of a premium tax credit, when you file your taxes, when you reconcile that premium tax credit, you’re going to have to pay the IRS back if you have underpaid your share of the monthly premium.
CM – And that’s not something we want any of our customers to have to do in March and April. VB – Exactly. They get a little fussy when they find out they owe money for health care. CM – Yep. So just remember if it is not open enrollment, whether you’re on Medicare or on individual health insurance, there are some options to change during the year and we call those Special Enrollment Periods and sometimes we shorten them to SEPs. So we’ll say, ‘Oh, do you have a SEP?’ And you’ll look at us like we’ve got five eyes, but it’s a good reason.
VB – Exactly. And please remember that if you don’t have a qualifying life event, you don’t qualify.
CM – And then you have to wait for those open enrollment periods. And that’s not fun either. So make sure you do your due diligence during the open enrollment periods for Medicare. Again, that’s October 15th through December 7th. For individuals, it starts on November 1st and goes through December 15th. Every single year just make sure you’re doing your due diligence, you’re checking your forms, you’re checking to make sure everything’s up to date, your prescriptions and your doctors are in-network because you don’t want to find out later in March that you owe money.
Premium Tax Penalty Lifted
VB – Some of the questions we get have to do with the premium tax penalty, and I will let you know that the penalty was lifted in 2019. Now, it is still mandated that you have health care, however, there is no penalty for not having health care anymore. The penalty has been repealed, but there’s still a lot of very great plans out there with very good prices. So I still encourage all of my clients to stay on health care because they have it and it’s a good thing.
CM – It is a good thing. Every once in a while we hear stories of people getting diagnosed with cancer or having a major life event, maybe an accident on the highway, and having that health insurance for at least that maximum out-of-pocket to say, okay, that’s a lot of money that we’re paying out, but we’re not going to be losing our home because of medical bills.
VB – Exactly, and I have had people come to the office and say, I was just diagnosed, and I need health insurance. Well, you can’t get health insurance just because you’ve been diagnosed with something. It’s that law of large numbers. They want the healthy dollars in there as well. They don’t want you to wait until you’re diagnosed with something to get health care because all they get are claims. They need healthy dollars in there as well. So it’s important to have that continual health care.
CM – So, pay attention during open enrollment. If you do have a Special Enrollment Period, come see us at Bancorp Insurance right here in beautiful La Pine, Oregon, or give us a call at 1-800-452-6826. You can also find us online at www.bancorpinsurance.com.
VB – Stay healthy.