What to Do if you Miss the Open Enrollment Period for NY State of Health

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The deadline for enrolling in a healthcare plan through the New York State of Health marketplace was December 20, 2014, for coverage beginning January 1, 2015. Anyone who did not enroll through the marketplace for coverage by that date would not have insurance coverage for January. However, the site is still open and New York residents now have until January 15, 2015 to enroll for a February 1 start date. But what happens if you miss both deadlines?

Who Needs Open Enrollment?

Open enrollment is for people who:

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1.  Need to enroll in healthcare coverage, and do not have access to an affordable, employer-sponsored plan; and,
2.  People who have previously enrolled for coverage through New York State of Health, and want to change providers or plans.
The current deadlines for open enrollment exist to ensure that everyone can register at New York State of Health, get subsidy information, and enroll in a plan as early as possible. It’s also to safeguard against people waiting until they are sick to enroll in a plan, by setting on time limit on when they can apply and get the subsidy.

What to Do if You Miss the Deadline

Missing the deadline for open enrollment can be problematic, because doing so means you won’t be eligible to apply for the subsidy, and you won’t be able to sign up for coverage through the New York State of Health marketplace until the next open enrollment period. However, you do have some options, even if you do miss the deadline for open enrollment.

Buy a Non-Marketplace Plan

The New York State of Health marketplace is not the only place where you can buy insurance. There are hundreds of individual providers, many of whom also offer marketplace plans, which can give you a quote outside of the marketplace. The big difference between buying a plan directly from a provider like USHealth Group is that you won’t qualify for the subsidy. However, brokers for any of these companies can help you find an affordable plan. Buying directly from a provider could actually have its benefits, because you might have a wider choice of plans and providers, than you would from a marketplace plan.
If you decide to buy a plan directly from a provider, you should check the industry and consumer ratings from sites like A.M. Best, Consumer Reports, and Angie’s List. You can also check sites like Glass Door to see how companies like USHealth Group and Humana rate with their employees and contractors.
You will also need to act quickly. Although there are insurance companies that can sell you a plan outside of the New York State of Health enrollment period, they might still have their own deadlines. Also, some providers might require a 90-day waiting period if you wait too long after the marketplace open enrollment period, to discourage people from putting off enrollment until they are sick.
If you can’t afford to buy a plan outside of the marketplace, you might still be able to qualify for a subsidized plan, or Medicaid.

Special Enrollment

Certain individuals could qualify for a special enrollment period if they are experiencing a major life change, such as:
·  Getting married;
·  Having a baby;
·  Moving to a different county;
·  Moving permanently to New York; and
·  Becoming a citizen.
The above are just a few examples of qualifying life events. If you believe that you have an event that qualifies you for a special enrollment period, you can visit the New York State of Health site for more information and help applying.

Medicaid

Even if you don’t qualify for a special enrollment period through the marketplace, you could still qualify for Medicaid. The good thing about Medicaid is that there is no open enrollment period; you can apply at any time throughout the year.
If you qualify for Medicaid, you will receive free or low-cost healthcare coverage, which could be more affordable than what you would get through the marketplace with the subsidy. Each state has its own eligibility requirements, and they are generally based on income levels, and disability status.
In addition to Medicaid, you can also see if your children qualify for the Children’s Health Insurance Program (C.H.I.P), which is essentially Medicaid for kids.
You can get information on New York Medicaid at Benefits.gov, or at the New York State of Health website.

Worst Case Scenario

The worst case scenario is that you cannot get any coverage at all, until the next enrollment period, which means you won’t be protected if you get sick or have an accident. The good news is that there are government-sponsored community health clinics across the country, that offer preventative care, sick care, pregnancy care, dental care, pediatric care, and mental health and substance abuse counseling. These clinics usually charge fees on a sliding scale, based on your income.

The Penalty for Not Enrolling

As you may know, the federal government charges a tax penalty for anyone who does not have healthcare coverage. In 2014, the penalty was one percent of your yearly household income, or $95 per person per family ($47.50 per child under age 18), whichever was higher.
The penalties for 2015 are two percent of your household income, or $325 per person ($162.50 per child under age 18), whichever is higher.
However, the government does make exceptions based on income. If you are unable to purchase health insurance at all this year, go to the New York State of Health marketplace, or go to Healthcare.gov, to determine if you qualify for an exemption from the tax penalty.


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