Enrolling in the New Health Insurance Exchanges

Enrolling in the New Health Insurance Exchanges

Eileen St. Pierre, The Everyday Financial Planner

There are a lot of questions we want answered regarding the running of the new health insurance exchanges, especially from partner organizations (like The Everyday Financial Planner) who want to assist the public in understanding this new system.  The Center for Medicare & Medicaid Services (CMS) has started to offer training to these groups.  From my point of view, things are starting to come into focus.

First, let’s define some terms.  The public uses the term “Exchange” to describe this system of purchasing individual health insurance plans.  The government refers to this system as “The Marketplace” since it is designed to be a one-stop shop for health insurance including Medicaid and CHIP (Children’s Health Insurance Program).

Initial Open Enrollment

The initial open enrollment period runs from October 1, 2013 through March 31, 2014.  Timing is important when signing up.  To have coverage start on January 1, you need to enroll by December 23.

  • This includes the 110,000 people currently enrolled in the Pre-Existing Condition Insurance Plan (PCIP).  This program ends at the end of this year.  For those of you in this plan, you will need to sign up for coverage in the Marketplace – there will be no automatic transition.  Don’t worry if you forget.  You will be mailed notices reminding you to do so.

If you enroll between the 1st and 15th day of January – March, your coverage will be effective on the first day of the following month.  If you enroll between the 16th and the last day of January – March, your coverage will be effective on the first day of the second following month.  Sound confusing?  Here are a few examples:

  • If you enroll on December 20, your coverage will begin on January 1, 2014.
  • If you enroll on January 2, your coverage would also start on February 1, 2014.
  • If you wait until the last day of the enrollment period, March 31, your coverage would not start until May 1, 2014.

Your first premium must be received before enrollment begins.  CMS is still working with plan providers on forms of payment.  You do not need a bank account to participate.

Special Enrollment Periods

After the initial enrollment period ends, you will not be able to sign up or change plans unless you experience a qualifying event that triggers a special enrollment period.  Examples of qualifying events include:

  • Moving to a different state
  • Gaining or becoming a dependent
  • Becoming a U.S. citizen
  • Gaining or losing eligibility for premium tax credits (I will discuss tax credits in an upcoming column)

The Affordable Care Act includes the permanent reauthorization of the Indian Health Care Improvement Act, which provides unique provisions for Native Americans.  Native Americans (members of federally-recognized tribes) may enroll or change from one qualified health plan to another one time per month.

Annual Open Enrollment

After the initial open enrollment period ends, the annual open enrollment period will run from October 15 to December 7 (subject to change).  So if you enroll in a plan for 2014 and wish to change plans for 2015, you will have to wait until October 15, 2014 to make the switch.

Ways to Enroll

You can enroll in the Marketplace in 4 ways:

  1. Online at www.Healthcare.gov
  2. By mailing in your application (we all know how long that can take)
  3. By calling the Toll-Free Call Center at 1-800-318-2596
  4. By getting in-person help from Navigator organizations (a list of these organizations will be released in mid-August)

Your application will be verified with data from the Social Security Administration, IRS, Department of Defense, Homeland Security, and other approved sources. If you apply online, you are supposed to get results in real time. Questions on the application are not supposed to be too intrusive.

I did find it interesting when a CMS training moderator mentioned that there would be a question regarding foster care.  This question only needs to be answered by those ages 18 to 25 as it relates to a new Medicaid category for people aging out of foster care.

In a Google Hangout held earlier this month, the CMS representative mentioned that they would be partnering with libraries to provide internet access and help with enrollment.  No details of the program were given.

Participating in the Marketplace is not mandatory.  If you receive health insurance through your employer and are happy with the plan, you do not need to worry about this.  If it is too expensive to include your family on your employer’s plan, they can enroll in the Marketplace.

Visit my Health Care Reform page for more information.

This column was updated on 12/10/13.