Final Call For Questions On Health Insurance As Deadline Looms

Mar 24, 2014
Originally published on March 25, 2014 11:48 am

There's just one week left for most people to sign up for insurance under the Affordable Care Act. And as people race to meet the deadline, they still have questions about the law, and the sign-up process.

"Is there a deadline to enroll in a health plan?" asks Josephine Ilog of Manteca, Calif. "And what happens if a person misses that deadline?"

The deadline for this open enrollment period is next Monday, March 31. And while previous deadlines have been a little fluid, the Obama administration, including the president himself, has been firm that this deadline is really the deadline.

This affects not just the health exchanges. After March 31 you won't be able to buy individual health insurance at all unless you have some special circumstance during the year, such as losing your job, getting married or moving. If you miss the deadline you will have to wait until the next open enrollment period. That's not until November. And that insurance won't start until next January.

So if you're uninsured and you can afford insurance, you need to get signed up before next Monday or you could find yourself paying a penalty with next year's taxes for not having insurance.

However, the March 31 deadline does not apply to public programs like Medicaid or the Children's Health Insurance Program. If you are eligible for those, you can enroll anytime during the year.

"I can't figure out, using the given calculators, how to estimate my premiums," writes Fran Richardson from Berea, Ohio. She retired this year and says, "I know I would not be eligible for Medicaid because of my savings and other resources."

Actually, Ms. Richardson may be eligible for Medicaid. This is a big change a lot of people aren't aware of. In the past, if you had anything beyond the most minimal savings or assets, you couldn't qualify for Medicaid. But the Affordable Care Act is eliminating those asset tests, starting this year. So if you meet the income requirements, and you're in one of the states that's expanding the program to adults who don't have children and are not disabled - about half the states, so far- you're probably going to be eligible. Ohio is one of those states.

There are a few exceptions to Medicaid expansion, most notably for long-term care.

"Do the new rules apply to all insurance policies or just those you get through the exchanges?" Kellie Meehan from Atlanta, Ga., wants to know. Her husband has been denied coverage for care delivered after January 1 due to a pre-existing condition. He was told "the pre-existing rule only applies if you got it through the exchange."

Starting January 1, in most cases, insurers can no longer refuse to insure people because of pre-existing health conditions. This is why there is a deadline, so people don't wait until they are sick to buy insurance.

"Grandfathered" plans, those in existence as of March 23, 2010, are the only ones that don't have to meet the new rules. And those grandfathered plans can only be continued for existing customers, not sold to new ones.

As we pointed out last month, there are still some non-compliant insurance policies available on the market that allow medical underwriting, such as short-term "gap" policies . That insurance isn't included in the Affordable Care Act requirements.

"My daughter is moving back to the United States after living abroad for several years," writes Pam Badame from Buffalo, N.Y. "She does not have insurance and will live with us until she gets a job. She is 37 years old. Does she have to include my husband's or my income when she fills out the form for the affordable care?"

For this I actually asked a tax adviser who's been working on this issue. He said it depends whether the daughter will be claimed as a dependent by her parents. If not, then she doesn't have to count their income. And because New York is one of those states expanding Medicaid, at least at first, she'll likely be eligible. If she gets a job, and that job doesn't come with insurance, she may then be eligible for a subsidy to buy coverage from a health exchange.

And because she's experiencing a life-change, by moving back to the US, she'll be eligible to buy insurance outside the normal open enrollment season. She's one of those people for whom March 31 is not the deadline to buy insurance.

With open enrollment coming to an end, so is this series. So no more questions please. But you can find the answers to all of your previous questions on the Affordable Care Act here, at our interactive app.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

OK, And now it is time for the final round of your questions about the Affordable Care Act. There is just one week left for most people to sign up for insurance in this open enrollment season. We thought this would be a natural time to bring to a close our monthly check-in with NPR health policy correspondent Julie Rovner.

So for one final time, Julie, let's get to it.

(LAUGHTER)

JULIE ROVNER, BYLINE: OK, David.

GREENE: So, our first question this month comes from Josephine Ilog of Manteca, California. And it seems pretty timely actually. She wants to know if there is a deadline to enroll in a health plan. And what happens if someone misses that deadline.

Julie.

ROVNER: Yes, there is a deadline. The deadline for this open enrollment period is next Monday, March 31st.

GREENE: Soon.

ROVNER: Yes. And while previous deadlines have been, shall we say, a little fluid, the Obama administration - including the president himself - have been pretty firm about saying that this deadline is really the deadline. And it's not just that you won't be able to buy health insurance through a health exchange after the deadline. Unless you have some special circumstance during the year - you lose your job, you get married or you move, for example - you won't be able to buy insurance at all until the next open enrollment period, which isn't until November. And that insurance won't start until next January.

So if you're uninsured and you can afford insurance, you need to get signed up before next Monday, or else you could find yourself paying a penalty with next year's taxes.

GREENE: OK, so a serious deadline and also consequences for missing it. Let's go to the next question. It comes from Fran Richardson. She's from Berea, Ohio.

FRAN RICHARDSON: I may retire this year at age 61, so my income would stop. I know I wouldn't be eligible for Medicaid because of my resources and/or savings. I can't figure out, using the given calculators I find online, how to estimate my premiums for health insurance.

GREENE: Can't figure out. I think those are words that we've heard from a lot of people during this whole process. Can you help out Fran Richardson?

ROVNER: Yes, actually, I can. Because in fact, Ms. Richardson may well be eligible for Medicaid. This is a big change a lot of people don't know about. In the past, she would have been correct. If you had pretty much any savings or assets, you couldn't qualify for Medicaid. But with only a few exceptions, the Affordable Care Act is eliminating those asset tests starting this year. So if you meet the income requirements, and you're in one of the states that's expanding the program to adults who don't have children and are not disabled, you're probably going to be eligible. And in fact, Ohio is one of those states that's expanding the program.

GREENE: Where Fran Richardson lives.

ROVNER: That's right.

GREENE: So maybe good news for her. All right. Kellie Meehan from Atlanta Georgia has a question about some new rules when it comes to consumer protections. And she wants to know if they apply to all insurance company policies or just those that are being sold through the new insurance exchanges. She says, for example, she's being told that the rule eliminating exclusions for preexisting conditions only applies to policies purchased through these exchanges. Is that the case?

ROVNER: Actually, this is a little bit more complicated than it seems because we're in kind of a transition right now. But generally, every new policy being sold in the individual or small business market, whether it's inside or outside a health exchange, has to meet at least some of the new consumer protections. And starting back this past January 1st, the rule eliminating preexisting conditions is one of those that every insurer has to follow. That's exactly why there's a deadline to buy coverage - so people won't be able to wait until they get sick to buy insurance.

GREENE: All right. Another question here from Pam Badame, from Buffalo New York. She has a question about boomerang children.

PAM BADAME: My daughter is moving back to the United States after living abroad for several years. She will not have health insurance and will live with us until she gets a job. She is 37 years old. Does she have to include my husband or my income when she is applying for the Affordable Care?

GREENE: So interesting question. Whose income actually counts when applying for coverage here? The individual or the whole family?

ROVNER: Well, for this one, I actually asked a tax adviser who's been working on this issue. He said it depends whether the daughter will be claimed as a dependent by her parents. If she isn't then she doesn't have to count their income. And because New York is one of those states that's expanding Medicaid, at least at first she'll likely be eligible. Once she gets a job, depending on her income, if that job doesn't come with insurance, she may be eligible for a subsidy to buy coverage from the health exchange.

And remember, because she's experiencing a life-change - she's moved back to the U.S. - she'll be eligible to buy insurance outside the normal open enrollment season. She's one of those people that the deadline doesn't apply to. Everyone else though, it's next Monday.

GREENE: All right. A few exceptions, but for most people next Monday is the day. NPR's Julie Rovner. Thank you. I want to take a chance to say that for doing this. I mean a lot of these questions you've told us, it's not like you do them off the top of your head, you really have to do some research. So we really appreciate it.

ROVNER: Thank you.

GREENE: And just a reminder, all of our previous segments with Julie and answers to many of your other questions about the Affordable Care Act are available at our interactive app - npr.org/aca.

(SOUNDBITE OF MUSIC)

GREENE: You're listening to MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.