Stuck Without Health Insurance? Things You Can Do…

Posted: September 08, 2014

by Wendy Barnett

Due to the Affordable Care Act, the way people obtain their health insurance is different now.  They must apply and enroll during an Open Enrollment period or they must have a qualifying life event or “triggering event” which creates a special enrollment period for them. Some common types of triggering events are if you move to or within California, if you get married, or if you lost your health insurance due to a job loss.

For this year, Open Enrollment ended on March 31, 2014. It will re-open on November 15, 2015 and go through February 15, 2015.  So what do you do in the meantime if you did not enroll during open enrollment?  Or what do you do if you did enroll, but your plan was cancelled because you didn’t pay your bill?

There are 2 options for people who are “stuck” without health insurance.

Short Term Health Insurance is temporary health insurance that is mostly for catastrophic coverage.  This means that although you will need to pay for the smaller services like doctor’s visits, prescriptions, or lab work, you will still be protected from the larger medical expenses like hospitalization.  Short Term Health Insurance covers you while you are waiting for Open Enrollment to Re-Open.  Here is a quick synopsis of the pros and cons of Short Term Health Insurance:

• You can apply at any time.  You are not limited by an open enrollment period.
• It typically costs less than standard health insurance plans.
• It covers big ticket items after the deductible is met such as ambulance transport connected to a hospitalization admission, hospitalization itself, and urgent care.
• It allows you to personalize your coverage by choosing your deductible size, your co-insurance, and the maximum limit that the insurance carrier pays.
• It can be started as early as 24 hours after the application has been submitted.
• It does not meet the “Mandate” to have Minimum Essential Benefits which means you will still be subject to the penalty placed by the Affordable Care Act.
• It does not cover pre-existing conditions.
• The maximum length of time you can keep it is 6 months.

Go Without Health Insurance Until the Next Open Enrollment 

You can go without any health insurance until the next Open Enrollment, but keep in mind the following:

• You will be subject to the penalty for not having insurance which, for 2014, is $95 per person or 1% of your income.
• You will have to pay full charge for all of your medical services and be exposed to the risk of having major medical expenses if something “big” happened such as a hospitalization.
• Helpful tip: If you choose to go without insurance, mark your calendar for the next Open Enrollment Period so you will not be “stuck” without insurance again. (This year Open Enrollment will be from Nov. 15, 2014 – Feb. 15, 2015 and can be effective starting Jan. 1, 2015.)

To sum it all up, if you are stuck without health insurance, you are subject to the penalty with either option if the time period is more than 3 consecutive months.  So the important factor is your comfort level.  Are you comfortable going without health insurance and taking the risk that you’ll be temporarily exposed to catastrophic incidents?  Or are you more comfortable having Short Term Health Insurance which gives the peace of mind that you’ll be covered for major medical expenses until you can get more permanent insurance in place? 

Please note that if your income is below 138% of the Federal Poverty Level, you may be eligible for Medi-Cal which can be applied for at any time.  You are not limited by special enrollment or open enrollment periods when you are eligible for Medi-Cal.

For more information and to discuss your options, give our agency a call at 1-877-752-4737.