Open Enrollment…Missed The Boat?

cruiseMissed the boat for open enrollment? The good news is that your ship may not have sailed yet. There are three exceptions under which you may still obtain health insurance coverage.

Exception one –  a “Qualifying Event” 
If you are moving from one state to another, turning 26 and moving off of your parents’ health plan, getting married or divorced, losing coverage due to the loss of a job or are coming off COBRA you have what is referred to as a “qualifying event”. You have 63 days from the loss of coverage due to a qualifying event to purchase health insurance.

You operate a small business and file (or will file)  your taxes as a 1099. This includes sole proprietorship, LLC or S Corp. Whether your business is your primary income or something you do on the side, operating a small business is your ticket to obtaining health insurance outside of open enrollment even if there is no “qualifying event”. Many folks don’t realize this, but the generation of a schedule “E” at the end of the year would also qualify you as a small business. So if you have rental income, specifically, the basis of income is for a property you rent, you also qualify.

Is my business too small?
I work with a client who teaches guitar lessons outside of his regular job (which also doesn’t offer health insurance). As a guitar instructor my client makes well under $10,000.00 annually. Upon initial contact my thoughts were that my client had missed open enrollment and that there was no “qualifying event”.  The fact that my client’s part time business as a music instructor generates income was the ticket he-we needed.  A few questions later he was well on his way to obtaining coverage.

Additional benefits…

Write this off. My guitar instructor client is technically self – employed, a small business owner or what is known as “a group of one”. Now during tax time my client can write off the health insurance premiums.

Flexibility. As a small business owner and a “group of one” my client now has the added advantage of being able to change carriers throughout the year if better coverage is needed. This is very different  from what options would have been available had we elected the “non group” option. As an individual (non group) you are locked into your plan until the next open enrollment. So what? My client is extremely healthy and wants the least costly insurance available to save on his monthly premiums. He opts for a plan which is only going to cost him $323.00 per month as opposed another plan which may cost him $623.00 monthly. The $323.00 plan has a $2,000.00 deductible and 30% co-insurance. The $623.00 plan has no deductible and a $100.00 co-pay. He is planning to have knee surgery and would like the better coverage but doesn’t need the more costly plan for the entire year. So he enrolls in the $323.00 plan and saves $300.00 per month on his monthly premiums. As a “group of one” he is now allowed to “bump up” his coverage to the non deductible plan in time to have his surgery and can be covered under the no deductible plan. After his surgery is complete he can now switch back to a less expensive carrier *** or plan with a higher deductible to save money on his monthly premiums.

Exception Three – No “Qualifying Event”, Most important topic here!!!

So you once had a qualifying event but were never told you had 63 days to comply, or to pick a plan. Or you missed open enrollment because you were told you were going to get on a group plan but that group plan didn’t come through because the group’s open enrollment doesn’t align with the National Open Enrollment. Or maybe you were just never given the information. I find this category to be the most important game changer. Don’t fall for cheap plans that don’t meet the state’s Minimum Creditable Coverage (MCC) requirements, meaning the plan falls outside of the parameters of what would qualify you as having coverage throughout the year. We improve your situation by applying for a waiver with the State. It’s not a secret, it just isn’t well-publicized. After the state grants us the waiver, we can pick a plan from any carrier. The waiver process at best, takes up to two weeks.

*** A limitation to this is that you can only downgrade your plan within the same carrier x 1 per year.

In summary, exceptions to open enrollment for health insurance are

  • A qualifying event
  • Your status / a small business owner
  • A state waiver

So if you happen to meet one of these exceptions and were thinking that it was necessary to wait until the next open enrollment, a qualified health insurance plan is a simple phone call away. Why not call today? Your ship awaits. Robert Rhodes, Commercial Insurance Broker, The Cortez Group, Inc. 781-354-0395

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About the Author:

Bob Rhodes enjoys a home in Dracut with his wife Andrea and their two sons. He spent the early part of his life in Maine and moved to Massachusetts in 1988 after serving in the United States Army with the 82nd Airborne Division. He graduated from Salem State College (University) with a degree in history. He loves reading, eating good food, going to the movies and traveling. Bob is inspired by the idea of helping his clients fulfill their goals of income security. He is an an expert in the Long Term Care and Health Insurance fields. He has been in the Insurance Field for several years and volunteers his time with local government and Trade Organizations.

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