Friday, January 17, 2014

Obamacare Open Enrollment is ending soon. If you have pre-existing conditions you need to understand the new rules…

C. Steven Tucker: Today is January 15, 2014 and today is the last day to enroll in an individual (non employer sponsored) health insurance plan with a February 1, 2014 effective date. After tomorrow, the next available effective date will be March 1, 2014. In fact the first national “open enrollment” period is quickly coming to a close. The last date to enroll in any individual major medical health insurance plan will be February 15, 2014 for a March effective date. So, if you have a preexisting condition or are one of the 6.3 million policy holders who have lost your plan because of the PPACA (Obamacare) you need to start familiarizing yourself with how “open enrollment” works now, not later now.

The old rules are gone

The old rules pertaining to purchasing health insurance in the individual major medical market are now gone. You can no longer purchase individual major medical health insurance coverage whenever you want, all year long. There are now specific time periods where this kind of coverage will be available in 2014 and in subsequent years. Those periods are called “open enrollment” periods. Outside of those “open enrollment” periods individual major medical health insurance coverage will not be available for sale. This means that you will not be able to get coverage for preexisting conditions.

This is why it is essential that you understand the new rules for they will affect you and everyone you know who has a preexisting condition or has lost their health insurance because of Obamacare. This is especially true because our existing state run high risk health insurance pools which provided guaranteed issue coverage for those who were declined health insurance coverage for decades before Obamacare are now being dissolved.

Buying insurance on and off the Obamacare exchange

It is important to know that you do not have to purchase health insurance at All products sold on and off the new Obamacare HIX – “Health Insurance Exchange Marketplace” will be guaranteed issue products during the two national “open enrollment” periods. They are:

Open Enrollment Period One: 1/1/14 – 3/31/14

Open Enrollment Period Two: 11/15/14 – 1/15/15

This means that you can not be denied coverage and no exclusion riders can be placed on your policy whether you buy the product on or off the Obamacare HIX but only during these two time periods. After these two time periods you can be denied coverage. In fact, individual major medical products will not be offered between these two national “open enrollment” periods. If insurance carriers continued to offer guaranteed issue coverage all year long it would lead to adverse selection. As it did in Massachusetts.

What you need to know right now

Since time is of the essence (and their is nothing timely about purchasing health insurance on the exchange). You need to know the only reason to purchase health insurance inside the HIX – Health Insurance Exchange Marketplace ( is if you qualify for an APTX – Advance Premium Tax Credit – (subsidy) to artificially lower the high cost of the Obamacare “Medal” plans – Bronze, Silver, Gold and Platinum. In order to qualify for an APTX your 2014 total household MAGI – Modified Adjusted Gross Income – income after taxes and retirement contributions must be less than:

$46,960 for an individual
$62,040 for a couple
$78,120 for a family of three
$94,200 for a family of four
$110,280 for a family of five
$126,360 for a family of six

If your income is more than the aforementioned amounts, you should purchase your health insurance outside of the HIX. The same plans are available off the exchange and the application process is much faster and far more secure. Again, all major medical health insurance products purchased inside and outside the HIX will be guarantee issue (no preexisting conditions) during the two national “open enrollment” periods in 2014.

PLEASE NOTE: The cheapest 2014 Obamacare “Medal” plan is the “Bronze” plan equivalent. This plan will expose a couple or a family to $12,700 in out of pocket risk each year for in network claims. For single applicants, that risk will be $6,350. So you are better off purchasing the Silver, Gold or Platinum plans if they are within your affordable range.

For Illinois residents the best priced 2014 ‘Medal’ plans are insured and underwritten by Blue Cross Blue Shield of Illinois a Division of Health Care Services Corporation. Find the right health insurance plan for you by exploring all of the plan options, save plans that fit your needs in your Shopping Cart and return to apply for coverage when you are ready. Don’t forget the last day for the Affordable Care Act (ACA) Open Enrollment is February 15, 2014.

To shop for all plans on and off the Obamacare HIX in all 50 states click the banner below:

A cheaper option for those without preexisting conditions

If you do not have any serious preexisting conditions, you can save a lot of money if you purchase a Temporary health insurance policy for a period of one year. These health insurance policies do not cover preexisting conditions nor do they include all of the federally mandated “Essential Health Benefits” such as Maternity, Drug Rehab coverage and Pediatric Dental. This also means that they are not considered ‘Qualified Health Plans’ meaning that you will be subject to the 1% of your MAGI penalty in 2014 if you purchase one of these plans. That stated the premium difference between these plans and ‘Qualified Health Plans’ is significant. Far outweighing the additional fine you would pay to the IRS in most cases.

To run quotes for a Temporary health insurance plan off the exchange click the banner below:

If that Temporary insurance quote engine does not work in your state click the banner below:

Very Important Note: Since the PPACA mandates that all health insurance policies cover preexisting conditions during the first national “Open Enrollment” period from 1/1/14 – 3/31/14 and the second national “Open Enrollment” period from 11/15/14 – 01/15/15. You can now safely purchase Temporary health insurance knowing that when your one year Temporary policy ends you will qualify by Federal law for any ‘Qualified Health Plan’ regardless of preexisting conditions during the second annual “Open Enrollment” period in 2014. Outside of those two aforementioned “Open Enrollment” periods you will not be able to obtain coverage for a preexisting condition. For this reason you must not purchase the 6 month Temporary health insurance option.

Only the 12 month Temporary insurance option is acceptable at this juncture. If you purchase a 6 month Temporary policy your coverage will end in between the two aforementioned “Open Enrollment” periods and you will not be able to obtain another policy that will cover a preexisting condition that you may develop during the first 6 months of Temporary policy ownership. HHS may yet provide us with further guidance as to whether or not the loss of a Temporary health plan outside of “Open Enrollment” periods will qualify as a “Special Enrollment” period in 2014 so that one could obtain a “Qualified Health Plan” on a guaranteed issue basis outside of “Open Enrollment” periods. As of the date of this writing no such guidance has been received.

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