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Spring is in the air, and the New York health insurance open enrollment is over, now what?

Apr 4th, 2014

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Spring is in the air and New York is finally starting to defrost after that brutal winter. To nearly mark the start of the warm weather the first open enrollment period for the Affordable Care Act has been ramping down. The last official day to sign up fora new york  health insurance plan at the New York State Health of health Insurance Exchange was this past Monday March 31st.

What does that mean for New Yorkers looking to enjoy their spring and summer without worrying about health insurance? Well it means that whatever exchange plan you’re enrolled in now (or not enrolled in), that’s the plan you’re stuck with until at least Jan. 1, 2015.

Are there any exceptions?

There are a few exceptions to this rule like for example if you lose your job and thus your health insurance, getting married, or having a child. You can find a detailed list of these circumstances that trigger so called “special enrollment periods” in the next section. It’s true the exchange plans have not been the most ideal solution to everyone’s health insurance needs. In fact many New Yorkers with new exchange plan have lost access to the doctors and specialists they’ve had for years. There are a number of reasons why people are losing access to doctors, but an in depth explanation is a little outside of the scope of this article. You can learn more about it here.

Because of that general dissatisfaction with the exchange many New Yorkers might find themselves contemplating dropping their plan at some point this year. An example situation might be someone who signed up for an exchange plan, but finds out that their preferred doctor or hospital is not covered by the plan.

A first reaction might be to try and switch to a new plan on the exchange. Or just cancel their plan right there and then, “Why should I pay for a plan that doesn’t even cover my doctors,” is the argument, and it’s a valid one for sure.

But it’s not as easy as simply dropping coverage and getting a new plan at the exchange. If you cancel your plan outright you’ll be unable to sign back up for a new policy at the exchange until the following year. You can of course explore New York State health insurance options off of the exchange but, none of those will include a federal health insurance subsidy.

Drop your New York health insurance plan, lose your subsidy for the year

A major selling point of the Affordable Care Act was the implementation of federal health insurance subsidies designed to make plans more affordable for lower income Americans. These subsidies can be huge if your income is close to 133 percent of the Federal Poverty Line (FPL), the lowest income eligible for subsidies before Medicaid. These subsidies are only available on health insurance plans sold at the New York State Health Insurance Exchange.  If you drop your exchange plan then you lose your subsidy in the process.

For many New Yorkers their subsidy amount might not be so much, maybe only a few hundred dollars in savings spread out over the year. But for those New Yorkers with lower incomes closer to 133 percent FPL their subsidy can be substantial.

How can I keep my subsidy if I switch plans?

You can keep your federal health insurance subsidy when switching plans by making sure that your circumstances meet those of the a so called “qualifying event”. Here they are listed out:

1. No-fault loss of Minimum Essential Coverage (Employer offered, Medicaid, or Chip)

2. Gaining a dependent through birth/ marriage/ adoption.

3. Gaining status as a citizen/ foreign national/ lawfully present alien.

4. You are a qualified individual who experienced an enrollment issue (subject to review, and can’t be the insured’s fault).

5. Change in income that makes an individual NEWLY eligible for subsidy, or a change in Cost Sharing Reductions (CSR) (specifically, a change in the amount of subsidy doesn’t count).

6. A permanent move of residence that offers new plan options.

7. Adequately prove to the exchange that the Insurer “substantially violated a material provision of it’s contract”.

8. Individual is an Indian (Native American, with government approved proof).

9. “Other exceptional circumstances, as determined by the Exchange or HHS” (I.E. a child with cancer will die if the plan can’t be switched).

Stuck until 2015

More likely than not you’re going to be stuck with the New York Health Insurance Exchange plan you picked during the open enrollment period. Sadly though many of you will come to find over time that the plan you picked does not fit your needs in some way, shape, or form. Whether it’s a doctor you thought was in network or a subsidy adjustment halfway through the year that throws your finances for a loop.

It’s not much consolation when you’re having health insurance issues, but next year’s open enrollment period is less than a year away. It starts November 15, 2014 and lasts until Jan. 15, 2015. Until then you have plenty of time to start researching a better plan for your needs.

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email info@nyhealthinsurer.com