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Short Term as Bridge to Open Enrollment

"I missed Open Enrollment"

Four words we've heard repeatedly since April of 2014.

 

The new world of health insurance is filled with new rules, deadlines, and buzz words.

One of the big changes from the ACA (Affordable Care Act) law deals with WHEN you can apply.

 

The How, What, and Where has also changed but the When is what we'll address here.

 

Let's look at the use of Short term health insurance if you have missed Open Enrollment

 

 

First, what and when is the Open Enrollment?


Basic Open Enrollment guidelines

 

Since the new ACA law, individuals and families have two different times they can apply.

 

1. Open Enrollment

The first is called the Open Enrollment and it generally runs from Nov 1st to Jan 31st in California.

The earliest available effective date (even with a Nov 1st enrollment) will be Jan 1st for Open Enrollment.

 

Outside of loss of group coverage, effective date is based on when application is submitted:

  1. ACA Application submitted 1st-15th, eff date is 1st of following month
  2. ACA Appplication submitted after 15th, eff date is 1st of the month after next month.

 

This can be subject to change from year to year so check with us for updated info at 800-320-6269 or help@calshortterm.com

 

This means that we need to enroll during this time or we may have to wait until Open Enrollment of the following year.

 

Unless we have a Special Enrollment Period trigger.

 

2. Special Enrollment Period

Outside of Open Enrollment, we may be able to enroll in an ACA compliant plan if we experience major life changes.

 

Here's a list of the most common triggers:

  1. Loss of employer based health insurance including Cobra exhaustion
  2. Move to or within California providing the move changed health insurance options
  3. Change in family status such as marriage, divorce, birth, death
  4. Change in legal or immigration status

 

These are the big ones that account for 99% of the SEP's that we see.

Generally, the change needs to have occurred in the past 60 days to qualify.

What can a person do if they don't qualify for either option?


Short term health to the rescue

That's where short term health plans are really helpful.

 

Short term health insurance can be applied for and enrolled anytime of the year.

In fact, the biggest use we see these days for short term is for people who have missed Open Enrollment.

Short term is even more flexible in terms of effective dates available.

 

We can request midnight following online app submittal as the effective date.

 

We usually have a confirmation in 48 hours for most applications.

 

What about the duration of the short term plan. Just how short is short?

The new short term plans are designed to run from a minimum of 30 days to up to 11 months.

They will not renew beyond the 11 months and you would need to re-apply at that point.

Keep in mind that short term plans are medically underwritten which means that we need to qualify based on health.

A person can be declined from enrolling on a short term plan.

One note...the health history questions are more serious in nature so most people qualify for coverage.

This is called simplified issue...and we're big fans.

 

Approximately 80% of applicants are approved for coverage.

 

You can take a look at the health history questions on the application to see if there might be an issue.

 

Access quote and online enrollment option here:

 

 

 


Payment and duration options till Open Enrollment

 

With short term plans, you have different options for payment:

  1. Pay monthly up to maximum number of months
  2. Pre-pay for a fixed and defined period of time

 

The monthly works well if cash flow is a concern or if you may have other coverage (for example, with a new job) before the maximum # of months.

There can be a discount depending on the carrier for pre-pay for longer period of time.

 

We recommend the pre-pay option only if you are sure of the amount time for which you'll need the coverage.

 

For example, let's say it's August and you won't have coverage till Jan 1st.

Pre-paying might save you money in that case.


Differences between Short Term and ACA plans

We may not have an option is you missed Open Enrollment and are not eligible for a Special Enrollment trigger, but there are some key differences.

 

 

 

Short term differences:

  1. You may be subject to ACA fine with short term coverage
  2. Short term is medically underwritten, you can be declined based on health
  3. Short term does not cover pre-existing conditions
  4. Short term does not cover RX, preventative, and other ACA required benefits
  5. Short term is not guaranteed renewal...this means it will eventually end

 

Those are important differences to understand. Again, we may not have an ACA options (same rules apply in or out of Covered California).

 

Some of the benefits of Short term:

  1. Generally less expensive in monthly premium
  2. More catastrophic coverage
  3. Faster and simpler online enrollment process
  4. Quick effective dates
  5. Can enroll any time of the year

Quick Summary and Calculation

Here's the deal, if you CAN qualify for an ACA plan AND it's affordable to you, that's probably the way to go.

Especially if you're getting a tax credit OR if the tax penalty will outweigh the premium savings of Short Term.

 

If you CANNOT enroll in an ACA plan (not in Open Enrollment and no SEP life trigger), then Short Term is the best alternative to get you out to the next Open Enrollment.

 

We can help you compare both options especially since the ACA tax credit and SEP calculation is very complicated.

Over 50% of people who self-enroll have wrong information in the system which results in them missing tax credits or getting too much and having to pay it back in April.

 

Our services are free as Certified Covered Ca agents so we can compare all options.

All options. No cost for services. How can we help you!

Call us at 800-320-6269 or request your Short Term Health Quote.


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from ME

"a million thank you for your prompt attention to all the details concerning this process. You've made it that much easier to enroll."

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"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

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"You are my new best friend. A HUGE thank you again.

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About CalShortTerm

 

Short term health insurance can be a valuable tool to help protect people during transitional times.  Understanding the pro's and con's of short term insurance versus ACA compliant plans is Invaluable

We are Licensed California Agents with 20+ years of experience helping 1000's of California individuals and families.

Call us. you will be pleasantly surprised 800-320-6269

 
 
 
 
Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit

800-320-6269

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