health insurance outside open enrollment

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Topic Author
x3t4a7
Posts: 16
Joined: Tue Jan 15, 2019 4:25 pm

health insurance outside open enrollment

Post by x3t4a7 » Sun Apr 07, 2019 4:19 pm

hi all--

i've run into a strange situation with my health insurance. in late 2018 i left my job and opted into COBRA for insurance, but earlier this year, i discovered there was some snafu with my auto pay (i'm still not sure what the issue was), and the insurance company did not receive my payment for march 2019. to make matters worse, they had the wrong address for me on file. i hadn't moved, but somehow the apartment number for my building wasn't on the address, so even though they sent 1 notice that my payment was overdue, i didn't receive it and they canceled my insurance.

my understanding is that the benefit administrators are incentivized to drop COBRA people since they cost money, and legally since I was overdue with my payment for 30 days, they are entitled to do so. the burden of proof is on me to prove that i paid, and since i was relying on auto-pay, i didn't. the company i originally worked at is now defunct, but were using a PEO to deal with benefits, who i suspect will not help me. i found this out on saturday so i've been stewing all weekend on this while offices are closed. i plan to call on monday but i suspect i may be SOL. logging into my account online, it shows my insurance as terminated.

unfortunately since getting dropped from your insurance for non-payment is not a qualifying event, i can't use the healthcare.gov marketplace until open enrollment next year. i live in california and short-term insurance plans were declared illegal in 2019.

i am very fortunate financially in that i have a fairly high NW (in the 5-10M$ range) and had planned to at least take 2019 off. that said, i really don't want to be on the hook for hundreds of thousands of dollars in case something serious happens with my health. i'm not sure what to do. 8 months is a long time to be uninsured.

i was wondering if anyone has any ideas for my situation. i'm willing to pay a very high cost for coverage, if it comes to that. could i potentially setup a business and buy a group plan out of that? i could employ my girlfriend part time, or another retired friend. it would only need to get me through the rest of the year. could i get away with paying my employees nothing and just providing health insurance? are there irs rules around this? is it ok if my business doesn't have any real income?

Shallowpockets
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Joined: Fri Nov 20, 2015 10:26 am

Re: health insurance outside open enrollment

Post by Shallowpockets » Sun Apr 07, 2019 4:31 pm

5-10 million net worth and you say you are prepared to pay. Just buy health insurance on the open market. Don't overthink it. I think you can afford it. What's with the starting a business, employing you girlfriend and other shenanigans in order to cheap out on the insurance.

Topic Author
x3t4a7
Posts: 16
Joined: Tue Jan 15, 2019 4:25 pm

Re: health insurance outside open enrollment

Post by x3t4a7 » Sun Apr 07, 2019 4:36 pm

maybe this is a dumb question but /can/ you apply for health insurance on the open market outside the AHCA open enrollment period? if so, how?

bob60014
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Re: health insurance outside open enrollment

Post by bob60014 » Sun Apr 07, 2019 4:43 pm

You will just be a retail customer paying out of pocket. Most if not all companies can sign you up directly from their website. Open enrollment wont matter.

Topic Author
x3t4a7
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Joined: Tue Jan 15, 2019 4:25 pm

Re: health insurance outside open enrollment

Post by x3t4a7 » Sun Apr 07, 2019 4:51 pm

i haven't found that to be the case.

on anthem.com, i get options for vision and dental but was told "Based on your zip code, you can apply for dental, vision, and life coverage by selecting the appropriate option below. However, medical products are not available at this time. If you still have any questions, please contact the number at the top of the page."

on unitedhealthcare.com, i was only offered only critical illness insurance (with pretty low lifetime maximum benefits), dental,vision, and a prescription discount card

on anthem.com i was told: "we don't offer individual health plans at this time" and was pointed to ehealthinsurance.com which also offers nothing.

that's why i was considering the small business option. of course if anyone can point me to somewhere i can buy health insurance outside open enrollment, that would be great.

quantAndHold
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Re: health insurance outside open enrollment

Post by quantAndHold » Sun Apr 07, 2019 4:55 pm

x3t4a7 wrote:
Sun Apr 07, 2019 4:36 pm
maybe this is a dumb question but /can/ you apply for health insurance on the open market outside the AHCA open enrollment period? if so, how?
Google “health insurance broker California”. Assuming you don’t have significant preexisting conditions, you should be able to get an individual plan outside of the exchange. It may or may not even be cheaper than what you can get from Covered CA.

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Phineas J. Whoopee
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Re: health insurance outside open enrollment

Post by Phineas J. Whoopee » Sun Apr 07, 2019 5:50 pm

With respect to special enrollment during the year, you can start an exchange-listed health insurance plan if you experience a qualifying event.

Losing your prior health insurance is among them.

I am not advising you to or not to use a health insurance exchange. I'm merely pointing out you're legally entitled to, if you act within 60 days of the loss of insurance.


See BruDude's post immediately below this one. Thanks again for the correction.

PJW
Last edited by Phineas J. Whoopee on Sun Apr 07, 2019 6:00 pm, edited 1 time in total.

BruDude
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Re: health insurance outside open enrollment

Post by BruDude » Sun Apr 07, 2019 5:56 pm

Loss of coverage due to nonpayment isn’t a qualifying event so that’s not going to work. There are no ACA health plans available outside of open enrollment without a qualifying event. Basically, you’re kind of screwed if there are zero short term options. I don’t know CA rules but there should at least be 1-3 month short term plans, I think it was only the longer duration plans that were made illegal. But nothing surprises me when it comes to CA...

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Phineas J. Whoopee
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Re: health insurance outside open enrollment

Post by Phineas J. Whoopee » Sun Apr 07, 2019 5:59 pm

BruDude wrote:
Sun Apr 07, 2019 5:56 pm
Loss of coverage due to nonpayment isn’t a qualifying event so that’s not going to work. There are no ACA health plans available outside of open enrollment without a qualifying event. Basically, you’re kind of screwed if there are zero short term options. I don’t know CA rules but there should at least be 1-3 month short term plans, I think it was only the longer duration plans that were made illegal. But nothing surprises me when it comes to CA...
You appear to be correct. I should have read further down the link I provided. Thanks, and I'll strike through my prior post so nobody gets confused.

Thank you again for the correction.

PJW

TravelGeek
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Re: health insurance outside open enrollment

Post by TravelGeek » Sun Apr 07, 2019 6:24 pm

x3t4a7 wrote:
Sun Apr 07, 2019 4:51 pm
... and was pointed to ehealthinsurance.com which also offers nothing.
I entered my old Bay Area ZIP code and the site offered me a whole bunch of choices.

(I am on COBRA, too, and I have monthly reminders on my to-do list to verify that my check has been cashed)

Topic Author
x3t4a7
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Joined: Tue Jan 15, 2019 4:25 pm

Re: health insurance outside open enrollment

Post by x3t4a7 » Sun Apr 07, 2019 7:18 pm

TravelGeek wrote:
Sun Apr 07, 2019 6:24 pm
x3t4a7 wrote:
Sun Apr 07, 2019 4:51 pm
... and was pointed to ehealthinsurance.com which also offers nothing.
I entered my old Bay Area ZIP code and the site offered me a whole bunch of choices.

(I am on COBRA, too, and I have monthly reminders on my to-do list to verify that my check has been cashed)
oh wow, you're right. i must've gotten twisted up into one of the million similar portals online. it does look like i can buy /some/ plan. not totally sure what the downside is here vs an AHCA approved plan (maybe the pre-existing conditions thing?). this is great though, definitely assuaged my anxiety.

Topic Author
x3t4a7
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Re: health insurance outside open enrollment

Post by x3t4a7 » Mon Apr 08, 2019 1:02 pm

just an update: i spoke to the benefits provider this morning and they admitted it was their error (accidentally disabling my auto pay and mailing the overdue payment notice to the wrong address) and reinstated my insurance after i paid. i pretty was shocked they were willing to do that but i'll take it.

Topic Author
x3t4a7
Posts: 16
Joined: Tue Jan 15, 2019 4:25 pm

Re: health insurance outside open enrollment

Post by x3t4a7 » Tue Apr 09, 2019 6:02 pm

in case anyone ever finds this thread... out of curiosity i called ehealthinsurance.com on the phone and they verified that in fact you can't buy health insurance from one of the big providers without a qualifying life event outside open enrollment, so if my cobra had been cancelled i would have really been in trouble. in california there is only one company that provides "short term" health coverage. the coverage seems sketchy at best but it's provided by Aliera. They stipulate that legally it can't be considered insurance.

TravelGeek
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Re: health insurance outside open enrollment

Post by TravelGeek » Tue Apr 09, 2019 6:49 pm

x3t4a7 wrote:
Tue Apr 09, 2019 6:02 pm
in case anyone ever finds this thread... out of curiosity i called ehealthinsurance.com on the phone and they verified that in fact you can't buy health insurance from one of the big providers without a qualifying life event outside open enrollment, so if my cobra had been cancelled i would have really been in trouble.
Thanks for that info. I wonder why that is.

Now I am even more paranoid about keeping track of my COBRA checks getting mailed and cashed :shock:

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MP123
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Re: health insurance outside open enrollment

Post by MP123 » Tue Apr 09, 2019 7:21 pm

TravelGeek wrote:
Tue Apr 09, 2019 6:49 pm
x3t4a7 wrote:
Tue Apr 09, 2019 6:02 pm
in case anyone ever finds this thread... out of curiosity i called ehealthinsurance.com on the phone and they verified that in fact you can't buy health insurance from one of the big providers without a qualifying life event outside open enrollment, so if my cobra had been cancelled i would have really been in trouble.
Thanks for that info. I wonder why that is.
Because then people would just wait until they got really sick before buying health insurance.

For ACA plans you can't get one outside of the (ever shrinking) open enrollment period unless you have a qualifying life event like getting married, moving, loosing coverage.

It's to keep healthy people in the risk pool and paying premiums.

TravelGeek
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Re: health insurance outside open enrollment

Post by TravelGeek » Tue Apr 09, 2019 7:43 pm

MP123 wrote:
Tue Apr 09, 2019 7:21 pm

Because then people would just wait until they got really sick before buying health insurance.

For ACA plans you can't get one outside of the (ever shrinking) open enrollment period unless you have a qualifying life event like getting married, moving, loosing coverage.

It's to keep healthy people in the risk pool and paying premiums.
Doh, yeah, that makes sense. Thanks.

Topic Author
x3t4a7
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Joined: Tue Jan 15, 2019 4:25 pm

Re: health insurance outside open enrollment

Post by x3t4a7 » Wed Apr 10, 2019 2:38 pm

conceptually it makes sense that you want to push people to have insurance before something happens, since the whole system depends on healthy people subsidizing sick people. that said, it seems wrong that an average person can get kicked off insurance with no recourse through small administrative errors. i was lucky, but this guy was not so lucky: https://thelifeofadiabetic.com/worst-da ... -coverage/

i was also told today that if you know how to navigate the bureaucracy, you can basically buy your way out of this. in california, united healthcare will sell plans to "small businesses" at any time. the broker told me i just needed articles of incorporation (or the equivilant for llc), an ein, and at least one other person as a part owner of the company (or an employee with proof of being paid with 1099). your company doesn't have to make money. it definitely seems like the system, as usual, is tilted against regular people who aren't equipped to understand the paperwork and tax implications of running a business.

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