I Missed Open Enrollment: Can I Get Health Insurance Now
In most states, the deadline for open enrollment ended December 15, 2019. If you missed this date, youre probably wondering how to get health insurance after open enrollment is over.
If you missed the window to make health care elections for 2020, you may still qualify for a special enrollment period . Some people in some situations may be able to purchase health insurance outside of the standard enrollment period. Were here to help you discover if you qualify and help you if you dont.
What Happens If I Miss Open Enrollment
The Affordable Care Act no longer requires everyone to have health coverage. You will not have to pay a tax penalty if you missed open enrollment and dont have coverage for 2020. However, going without health insurance could leave you at risk for high unexpected medical bills. Your options could include a special enrollment period, Medicaid and/or the Childrens Health Insurance Program , short-term health insurance, and supplemental insurance.
What Health Insurance Plans Are Not Considered Aca
If youre purchasing your own coverage, there is a wide range of health insurance plans that arent required to comply with the ACAs rules. These include short-term health insurance, Farm Bureau plans in Iowa, Indiana, Tennessee, and Kansas , travel insurance, accident supplements, limited benefit plans, fixed indemnity plans, and other supplemental or limited coverage.
As long as youre not in a state that has its own penalty for people who go without minimum essential coverage, youre free to purchase a plan thats not compliant with the ACA, and you wont be penalized for doing so. But your coverage wont be anywhere near a solid as it would be under an ACA-compliant plan. If you stay healthy, youll be fine. But if you end up needing extensive medical care, your non-ACA-compliant plan could leave you on the hook for substantial medical bills.
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Who Does The Individual Mandate Apply To And Who Is Exempt
Almost all U.S. citizens who did not have health insurance between 2010 and 2018 may still owe a penalty fee next year or in the future based on the individual mandate. This fee comes in the form of an extra tax you must pay for the time you didnt have coverage. People who qualify for a health coverage exemption for past years includes anyone who:
- Was incarcerated.
- Had an income that was so low that filing a tax return was not a requirement.
- Were members of a Native American tribe.
- Had a religion that objects to having health insurance.
- Belonged to a healthcare sharing ministry.
- Was in the U.S. illegally.
- Qualified for a hardship exemption.
- Paid more than a certain percentage of their income to their health insurance. The IRS set the exact percentage each year.
You can also visit HealthCare.gov to learn more about exemptions from the individual mandate and how to apply for an exemption if you qualify.
Starting in 2019, though, you do not have to pay any kind of penalty fee or tax if you do not have coverage, regardless of whether or not you qualify for an individual mandate exemption. However, there are a few states that still enforce the individual mandate which well talk about below.
What If You Don’t Have Health Insurance
More than 30 million Americans under age 65 had no health insurance in 2018, and that number is rising. Here’s what they risk.
For some people, health insurance might seem like something that’s not affordable or simply not a necessity. In fact, about 29 million people have no health insurance at all. And coverage cost is the main reason that about 45 percent of adults give for not having health insurance.
The costs of forgoing health insurance, however, may be more than just adding a monthly budget line item. There may be a penalty for not having health insurance. Those without health insurance have lower rates of preventive care than those with insurance, which may lead to lack of diagnosis for chronic or severe conditions. And health visits that do require care may lead to insurmountable medical bills. What’s the true cost of no health insurance? Here are some insights.
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Who Are The Uninsured
Most people who are uninsured are nonelderly adults and in working families. Families with low incomes are more likely to be uninsured. In general, people of color are more likely to be uninsured than White people. Reflecting geographic variation in income and the availability of public coverage, people who live in the South or West are more likely to be uninsured. Most who are uninsured have been without coverage for long periods of time.
- In 2019, over seven in ten of the uninsured had at least one full-time worker in their family and an additional 11.5% had a part-time worker in their family .
Figure 4: Characteristics of the Nonelderly Uninsured, 2019
- Individuals with income below 200% of the Federal Poverty Level 1 are at the highest risk of being uninsured . In total, more than eight in ten of uninsured people were in families with incomes below 400% of poverty in 2019 .
- Most of the uninsured are nonelderly adults. The uninsured rate among children was 5.6% in 2019, less than half the rate among nonelderly adults , largely due to broader availability of Medicaid and CHIP coverage for children than for adults .
Figure 5: Uninsured Rates among the Nonelderly Population by Selected Characteristics, 2019
- Nearly seven in ten of the nonelderly adults uninsured in 2019 have been without coverage for more than a year.2 People who have been without coverage for long periods may be particularly hard to reach in outreach and enrollment efforts.
Inability To Afford Medication
Many Americans rely on regular medication to treat chronic ailments. According to Bloomberg,
Americans spend more on prescription drugsaverage costs are about $1,200 per person per yearthan anyone else in the world. Its true that they take a lot of pills. But what really sets the U.S. apart from most other countries is high prices. Cancer drugs in the U.S. routinely cost $10,000 a month.
Like healthcare prices, the prices of prescription drugs have also increased. And although private insurers and the government subsidize a large portion of the bill, its still expensive. But without insurance, many Americans wouldnt be able to afford the high drug costs.
A KFF survey found that uninsured people frequently decide not to get the treatment their provider recommendsprimarily because of the costs. In 2019, 19.8% of adults under the age of 65 reported that they had delayed filling or simply didnt re-up their prescription because of drug costs.
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Will The Premium Be Lost If I Dont Pay
A missed payment does not necessarily mean you will immediately lose your insurance. The first time you miss a payment, you will likely have a grace period. This means that your insurance company will give you a certain amount of time to make the payment. The usual grace period is 90 days
If you do not pay each missed premium within 90 days, your insurance company may terminate your coverage. This has several major implications:
- You will not be able to use your premium insurance plan for future services
- You will retroactively lose coverage for any services you received during the grace period
- You will not be able to re-enroll in this plan until the next open enrollment period .
How Can I Avoid Missing Payments
Losing your insurance due to missed payments is not ideal. Your best bet is to be proactive to avoid missed payments.
Here are some tips to help you pay your premiums on time:
- Place reminders on your phone or other devices to remind you to pay
- Set up automatic payments on the insurance companys website for automatic payments.
Some tips to help you afford monthly payments every month:
- See if you qualify for a premium discount, which lowers the cost of your premiums based on your household income
- Check to see if you qualify for Medicaid, which may provide a low-cost or free insurance plan
- Choose a plan with a lower monthly premium
- Talk to your insurance company representative and ask for more help with paying your premium. That way, you can keep the health coverage you deserve.
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Ri Health Insurance Mandate
Health insurance is a requirement in the state of Rhode Island.If you go without continuous health coverage, you might pay a penalty when you file your taxes for 2022. See below for more information about the health insurance mandate and how it might affect you.
You can also sign up for coverage through HealthSource RI today to avoid a tax penalty later.
Hardship exemptions are available by applying through HealthSource RI. The application is available HERE and more information is available below.
The State of Rhode Island recognizes that the COVID-19 pandemic has brought about unusual and unanticipated circumstances for many individuals. As a result, HealthSource RI will accept applications related to COVID-19 hardships under the category of You experienced another hardship listed on page 7 of the application linked above.
Additional exemptions are available through the Rhode Island Personal Income Tax return. If you are looking for more information about additional exemptions from the penalty fee, please see the exemptions section below.
What If I Dont Enroll In Health Insurance At All
As of 2019, theres no more individual mandate. This means you dont have to enroll in health insurance to avoid paying a penalty fee, in most states.
If youre 30 or older and want to enroll in a Catastrophic plan, you must claim a hardship exemption to qualify. Catastrophic health plans offer more affordable coverage. And they can protect you from high medical costs if youre seriously hurt or injured. If youre under 30, you can enroll in a Catastrophic plan without any kind of exemption, though. For people over 30, youll need to qualify for a hardship or affordability exemption. Some examples of hardship exemptions are homelessness, domestic violence, the death of a family, or experiencing a fire or other natural disaster. Once granted an exemption, you can see every Catastrophic plan available based on where you live on the Marketplace.
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Higher Charges For The Same Services
Without health insurance you may get charged much more for care that would otherwise be covered by your plan. This is because no oneusually the insurance companywill be subsidizing your cost of care. As a result, you may have to pay higher charges for the same services. You will have to pay for everything out of pocket, and if you cannot afford the cost of care, the hospital or medical practice could take legal action against you.
Types Of Health Insurance
If you dont enroll in health insurance, there are a few things that can happen. Some people may not have any health insurance, while others may have only a limited selection of options. If you dont have health insurance, you could end up paying high premiums or being unable to get coverage if you need it.
There are a few different types of health insurance. You may be covered by an employer-sponsored plan, a government program like Medicare or Medicaid, or a private plan. Each type of coverage has its own benefits and drawbacks.
If you only have limited options, the best option might be a government program like Medicare or Medicaid. These programs are free for most people, and they provide comprehensive coverage for medical expenses. However, these programs have very strict eligibility requirements, so you might not be able to get coverage if youre not eligible.
If youre covered by an employer-sponsored plan, the best option might be to switch to a plan thats more affordable or offers better coverage. Employers offer a variety of plans, so its important to compare them carefully before making a decision.
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Risks Of Being Uninsured
Having or not having health insurance plays a large role in how healthy you are. Research shows that people without insurance are less likely to seek care. They are more likely to postpone or even skip the care they know they need. This can lead to the development of diseases that could have been prevented or cured with early treatment.
Often, the decision to forgo care hinges on other financial priorities, such as food or housing. But not having insurance can make your financial situation worse. You have a right to care in a true medical emergency:
A severe or life-threatening incident
Imminent delivery in a pregnant woman
Seriously impaired bodily functions or organs
However, if you don’t have insurance, you still will be responsible for paying all of your medical bills. Those bills could run into the thousands of dollarsmuch more than the average person can afford. If you have a catastrophic illness or develop a chronic disease, such as cancer or heart disease, the financial implications can be even more severe if you don’t have insurance.
How Much Does Health Insurance Cost
The average monthly cost of a Bronze plan on the ACA health insurance marketplace is $928. The average premium for a Silver plan is $1,217 and $1,336 for a Gold plan. Those monthly health insurance cost averages dont include federal government subsidies that can reduce the costs of an ACA marketplace plan.
The exact cost of an ACA plan varies based on multiple factors, including age, location, metal tier, type of health plan, household income and how many people are covered by the plan.
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Choosing A Health Insurance Plan
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
Problems To Have Without Health Insurance Plans
We have rightly pointed out the worst outcome of consuming savings and taking loans to deal with a medical emergency. But medical expenses dont stop with in-patient hospitalization expenses happen before and after hospitalization too! All that can be too much for you to bear without a health insurance plan, which covers the cost of hospitalization, and the ones that get incurred before and after it. Lets discuss all these in detail below.
How Many People Are Uninsured
After several years of coverage gains following the implementation of the ACA, the uninsured rate increased from 2017 to 2019 amid efforts to alter the availability and affordability of coverage. Coverage losses in 2019 were driven by declines in Medicaid and non-group coverage and were larger among nonelderly Hispanic and Native Hawaiians and Other Pacific Islander people. The number of uninsured children also grew significantly.
In spite of the recent increases, the number of uninsured individuals remains well below levels prior to enactment of the ACA. The number of uninsured nonelderly individuals dropped from more than 46.5 million in 2010 to fewer than 26.7 million in 2016 before climbing to 28.9 million individuals in 2019. We focus on coverage among nonelderly people since Medicare offers near universal coverage for the elderly, with just 407,000, or less than 1%, of people over age 65 uninsured.
- The uninsured rate increased in 2019, continuing a steady upward climb that began in 2017. The uninsured rate in 2019 ticked up to 10.9% from 10.4% in 2018 and 10.0% in 2016, and the number of people who were uninsured in 2019 grew by more than one million from 2018 and by 2.2 million from 2016 . Despite these increases, the uninsured rate in 2019 remained significantly below pre-ACA levels.
Figure 1: Number of Uninsured and Uninsured Rate among the Nonelderly Population, 2008-2019
How To Get Health Coverage
You can get health care coverage through:
- A group coverage plan at your job or your spouse or partner’s job
- Your parents’ insurance plan, if you are under age 26
- A plan you purchase on your own directly from a health insurance company or through the Health Insurance Marketplace
- Government programs such as
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Negotiate Your Hospital Bills
Hospitals may grant uninsured individuals discounts or allow patients to pay negotiated amounts over time. For example, negotiated bills are often split into monthly amounts. It is always best, when possible, to negotiate bills before you are hospitalized, such as for elective surgery or to have a child.
You can also ask the hospital ombudsman or payment department about financial assistance programs, sometimes called charity care that can adjust your bills to your ability to pay. In fact, non-profit hospitals are required by law to offer assistance plans to low-income patients.
In addition, sometimes applying for assistance can halt bill collectors. Hospitals would rather work out payments with patients for various reasons, including that collectors typically keep 50% of whatever they get from patients.
One more tip: If possible, you are usually better off negotiating with an ombudsman, who is there to resolve patient issues, rather than the billing department that exists to collect revenue.
Also, many individual doctors regularly work with patients who dont have the ability to pay the full cost of their care. Their policies vary but many physicians routinely cut bills in half for the needy and even may slash bills to as little as 10%.