You Signed Up for the Wrong Health Insurance

NEW YORK (MainStreet) — If you recently bought health insurance through one of the state exchanges or from a private insurer and feel like the plan does not mesh with your needs or lifestyle, your options to change to another one are limited.

Some consumers are unhappy with their plan because of what they are paying for co-payments or deductibles.

Others dislike the doctors or the hospitals on the network. Most people are stuck with their current plan until open enrollment begins again on November 15 unless they meet a "qualifying life event" such as getting divorced, moving from one coverage area or changes in your salary.

If you feel like an error occurred placing you in the wrong health plan, your best recourse is to contact the federal or state exchange as soon as you are aware of this information, said John DiVito, president of Flexible Benefit, a web-based insurance provider based in Rosemont, Ill.

"The individual may be eligible for special enrollment rights if enrollment in the health plan was made in error," he said. "Special enrollment periods provide individuals with a 60-day time period to make a plan change. Although they may be eligible for a plan change, the change may not be retroactively processed unless an error was made during the enrollment process by the exchange or the insurance company."

Consumers who are unhappy with their current plans should start looking at what plans the exchanges offer to see what is available, said Bankrate.com insurance analyst Doug Whiteman.

"If you feel like you bought the wrong insurance plan, you are out of luck," he said. "You have to wait until mid-November when open enrollment begins again."

While the current plans give consumers a general idea of what is offered, many insurers could increase prices in the fall, Whiteman said.

"The prices could increase in November if the exchanges did not get enough younger, healthier people to sign up and the balance is not correct," he said. "Consumers should be aware that prices for everything are rising all the time because of inflation."

Most people who are no longer happy with their current insurance plan are probably stuck with it whether they bought it from a government health insurance exchange, through a licensed agent or private online marketplace like eHealth, said Carrie McLean, director of customer care at eHealth.com, an online health insurance exchange based in Mountain View, Calif.

If you meet one of the "qualifying life events" such as getting divorced or married, having a child, relocating from one coverage area or state to another or experiencing changes in income which may make you eligible for Medicaid or possibly for subsidies, then you can buy another plan.

"It does not include simply dropping your coverage because you're no longer happy with it," she said.

Another "event" which qualifies is the loss of what the law terms "minimum essential coverage," which means the loss of coverage under any plan which meets the requirements of the Affordable Care Act.

Health insurance plans offered by large employers must offer a minimum value which is defined as satisfying a 60% actuarial value test. This means that a plan would pay for at least 60% of medical expenses on average for a standard population.

Consumers who experience a qualifying event typically receive a 60-day window to shop for and enroll in a new ACA-compliant health plan, McLean said.

"No one can turn you down," she said. "You can also apply for government subsidies during this period."

The logic behind not allowing people to buy a new major medical health insurance plan for themselves or their family at any time of the year is complicated, but has been designed to protect the consumer.

The Affordable Care Act prohibits health insurance companies from declining anyone based on his or her personal medical history.

"If you could sign up for coverage any time of the year, then people might only wait until they get sick before enrolling and if only sick people are enrolled in coverage, then costs are going to skyrocket," McLean said.

The nationwide open enrollment period was created to get people to enroll during a specific open window and make it hard to get coverage outside of that window.

"That way people can't wait until they get sick before getting coverage and we end up with a good balance of healthy and sick people in the market, which helps to keep the cost of coverage relatively affordable," she said. "If it's the monthly premium that's causing someone to sour on their health insurance plan or if they don't like their doctor or hospital network, they're just going to have to grit their teeth and wait for the next open enrollment period."

That period, of course, starts November 15, 2014 and will run through February 15, 2015. Coverage under new plans purchased during the next open enrollment period will begin no sooner than January 1, 2015.

Consumers can also look into purchasing supplemental forms of coverage like accident or critical illness insurance.

"These provide you with a cash payout if you experience a serious accident or get a bad diagnosis," McLean said. "You can use that money to help cover your deductible or other medical expenses. In fact, you can use it for whatever you like."

 

--Written by Ellen Chang for MainStreet

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