Obamacare insurance choices cut after deadline to enroll passes

The Fresno BeeMay 23, 2014 

California Health and Human Services Secretary Diana Dooley speaks at Fresno State during a stop to help promote Covered California health services. Sixteen states, including California, run their own exchanges under Obamacare.

MARK CROSSE — Fresno Bee File Photo Buy Photo

Thousands of people in the central San Joaquin Valley and statewide missed the Affordable Care Act deadline, and their options for health coverage are slim until the next enrollment opens six months from now.

Insurance experts say it's hard to know how many people opted to forego insurance and take a tax penalty and now have decided they want insurance, and also how many simply failed to sign up in time and now regret the decision.

But confusion over the new health law, also known as Obamacare, kept some from enrolling, health insurance experts say.

Some people thought they didn't have to meet the new health law's deadline because they didn't qualify for a premium subsidy from the federal government, said Carrie McLean, director of customer care at eHealthInsurance.com, a private Web-based insurance broker. Others thought that only people who wanted to purchase insurance through Covered California, the state's health benefit exchange, had to do so by March 31, she said.

And, according to a Kaiser Family Foundation survey in March, more than 60% of those without health coverage were unaware of the enrollment deadline for most people to sign up for individual health coverage.

Now they're stuck with a tax penalty, and no matter how much money they have to spend on insurance premiums, they can't buy a comprehensive, major medical policy until the next open enrollment in November. And in the meantime they can be turned down for pre-existing conditions by alternative plans.

A lot of people who missed the enrollment deadline have been calling eHealth, McLean said, and some need insurance because they're sick or injured.

They don't understand that you can't get sick and then call to get insurance, "just like you can't wreck your car and call to get insurance," she said.

The enrollment deadline was put in place to discourage people from waiting until they were sick to buy coverage. Health plans need healthy enrollees to offset the costs of those who have chronic health problems.

After the deadline, only people with a qualifying life event — birth of a child, loss of employer-sponsored health insurance or a divorce — can sign up for major medical coverage on the state exchange or in the private marketplace.

An exception: Covered California said this month that people with COBRA coverage could shop for lower-cost plans on the exchange through July 15. COBRA is a health insurance program that extends employer health plan coverage when a worker is not on the job and is more expensive because the employee must pay the premium portion typically covered by the employer.

"We are hearing from all kinds of consumers and we are now focused on educating those that are eligible for special enrollment," said Roy Kennedy, a Covered California spokesman. In the week that ended May 18, center employees answered 46,953 calls, he said.

Options are limited for those who didn't sign up by the enrollment deadline and are shopping for insurance coverage in the open market. Only short-term, accident or illness insurance policies are open to them.

But the policies can be a stop-gap solution.

Before the Affordable Care Act, short-term health policies mostly were sold to people who were between group health insurance plans, said Cala Carter, a Fresno insurance agent who is certified to help people enroll in plans through Covered California.

Now, the short-term policies are about the only solution for people who failed to meet the government's open enrollment deadline, Carter said. "So far, that's been the only alternative idea I've come across," she said.

Coverage varies by short-term plan, but most are affordable, McLean said. For example, a 30-year-old woman in Fresno could get a policy for $116 a month with a $5,000 deductible, she said.

But there are drawbacks: Short-term policies don't have to meet the minimum coverage requirements of the new health law, such as no exclusion for pre-existing conditions. Coverage can be denied to someone with diabetes, heart disease and other illnesses.

Accident policies also are an option, McLean said. The plans pay a flat amount for hospital expenses, doctor visits and other medical expenses.

McLean recommends working with a licensed agent to find a plan. "It doesn't cost you any extra," she said. "Don't try to think you have to get through this maze of health insurance on your own."

The reporter can be reached at (559) 441-6310, banderson@fresnobee.com or @beehealthwriter on Twitter.

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