Healthcare Options Outside Open Enrollment

Open enrollment has passed and will begin again on November 1, 2018, continuing through December 15, 2018. However, you still have some options if you missed 2017’s open enrollment period, or if you’re not so sure you want to keep your current plan.

Among the options available are special enrollment — if you have a qualifying life event, a short-term medical plan, or a healthshare program, which is becoming a popular solution to healthcare needs that’s less expensive than traditional health plans.

Special Enrollment Periods Following a Qualifying Event

If you’ve had a qualifying life event, you may be eligible for a special enrollment period. You’ll typically have 60 days from the date of the qualifying event to enroll in a plan.

The most common qualifying events include:

• Marriage or divorce
• Addition of a dependent – This includes the birth of a child, adoption, or having a child placed in your custody.
• Loss of health coverage – You may qualify for special enrollment if you lost your health insurance due to losing your job or if you became ineligible for Medicaid.
• Permanent move to an area – Moving to an area with different qualifying health plans may make you eligible for special enrollment. However, you must have had qualifying coverage for at least one of the 60 days prior to moving.
• Newly gained American citizenship
• Becoming newly eligible or ineligible for advance premium tax credits or cost-sharing
• Misconduct by an exchange or marketplace navigator, agent/broker, insurance representative, or health plan during enrollment
• Errors or contract violations that occur and are noted by the insurance exchange or state marketplace

Short-term Medical Plan

A short-term medical plan is another option if you missed open enrollment and don’t qualify for a special enrollment or are between jobs. Short-term medical plans provide benefits just like a major medical plan — but for a limited time. Plan periods range from as little as 30 days up to 3 months at a maximum.

A short-term medical plan does not meet the Affordable Care Act (ACA) requirements, so you may still be subject to a tax penalty. Hardship exemptions are available, however, including health plan cancellations, domestic violence, bankruptcy within the past 6 months, and several others.

Healthshare Program — An Increasingly Popular Solution

People from all walks of life are discovering value in healthshare programs, which are often more affordable than traditional health plans while also providing better coverage options. Healthshare programs have been around since the 1980’s but have seen a recent surge in awareness and popularity as consumers seek refuge from high health plan premiums and sizeable tax penalties.

Exempt from Obamacare Tax Penalties

Joining a healthshare program exempts you from the Obamacare tax penalty and requirements, providing a legal way to choose an affordable healthcare solution on your terms.

Healthshare programs are sometimes called Health Care Sharing Ministries (HCSMs) because they are often offered through faith-based organizations. However, some healthshare programs are non-denominational. Healthshares are federally recognized non-profit organizations but they aren’t insurance — so they aren’t subject to state and federal laws that govern health insurance. This structure helps to keep costs down while also providing better coverage options than many traditional health plans offered through the marketplace.

Healthshares, as the name suggests, share healthcare costs among healthshare members who make monthly contributions that are frequently much lower than premiums for traditional plans. Since their inception, over $1.5 billion in medical expenses have been shared — and as more people discover the savings and value in healthshares, membership in healthshare programs has grown to over 1,000,000 Americans.

Healthshare Advantages:

• Less expensive than Affordable Care Act (ACA) health insurance plans
• Exempt from tax penalties
• Negotiated discounts on services
• Professional Provider Networks (PPOs) / Larger networks than ACA plans

Is a Healthshare Right for You and Your Family?

Healthshares provide an even greater value for families because the savings are multiplied, but a healthshare program may not be for everyone. Because a healthshare is not health insurance, healthshares aren’t required to cover pre-existing conditions and most don’t cover pre-existing conditions for the first two years.

Healthshares often also require that you sign a “Statement of Beliefs”, but some healthshare programs are non-denominational. To promote a healthy lifestyle and to help keep costs lower, healthshares typically do not accept smokers — but some will if you agree to join a smoking cessation programs.

Open enrollment is behind us but you still have some coverage options, including some solutions that can be less expensive and provide larger networks than marketplace options. If you’d like to learn more about your options outside of the open enrollment period — or if you think a healthshare might be a better solution to your healthcare needs, reach out to our trained specialists to learn more.

Click here to schedule an appointment, or call 800-913-0172 to get started.    

To your health and wealth,

Wiley P. Long, III
President - HSA for America

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