Monday was the last day of open enrollment to buy health insurance through the Massachusetts Health Connector, the state agency that serves people who don’t get coverage from an employer. But Connector officials say their work is far from over. Here are answers for consumers about what lies ahead.
Now that the deadline has passed, does that mean it’s too late to get coverage for 2015?
A. Not necessarily. Although the open enrollment period ran from Nov. 15, 2014 to Feb. 23, 2015, the law allows people, in certain circumstances, to obtain coverage at other times:
1. If you qualify for MassHealth, the state’s Medicaid program for low-income people, you can sign up at any of time of the year.
2. If you have a “qualifying life event” — a change in your circumstances that affects eligibility — you can enroll within 60 days of this event. These events include losing your previous insurance, losing a job or having your hours cut, changing jobs to one that doesn’t offer affordable insurance, getting married, and having a child. But you have to act within 60 days of the change.
3. Massachusetts also has a special exception: Those who qualify for a federal or state subsidy to lower their premiums may apply for insurance through the Connector throughout the year. Once the Connector has determined that, based on your income, you are eligible for a subsidy, you have 60 days in which to select and pay for a plan.
Can people who do not qualify for a subsidy enroll outside the enrollment period? How about if they buy coverage directly from an insurer instead of going through the Connector?
A. No — unless you’ve experienced a qualifying life event as described above. Otherwise, you have to wait until the next open enrollment period later this year, and your coverage will start in 2016. This limitation applies equally to plans bought directly from insurers.
If a person turns 26 and can no longer be covered by a parent’s insurance, can he or she still buy through the Connector after open enrollment ends?
A. Yes. Involuntarily losing insurance is one of the life changes that permits consumers to use the Connector outside the open enrollment period. But you need to apply within 60 days of your 26th birthday.
Will doctors’ visits and other care be covered for people who paid their premiums by Monday’s deadline, but haven’t received an insurance card or confirmation that they are enrolled?
A. Yes. People who paid the first month’s premium by Monday will be covered effective March 1, even if they haven’t received their insurance cards. The online payment system does not confirm receipt of payments, but as long as the money has been withdrawn from your bank account, you can consider yourself covered. “If the money came out of your account, you don’t have anything to worry about,” said Connector spokesman Jason Lefferts.
Because it takes a few days to process the payment and the enrollment, some people may not get their insurance cards until after March 1. But their health care is covered retroactive to March 1. Each insurer has its own policy on how to handle reimbursements for people who have not yet received their enrollment packets. A link on the Connector’s home page (www.mahealthconnector.org) will take you to a page listing each insurer, and a second click will connect you with that insurer’s policy.
What happens to people who signed up for insurance but are still in the process of proving their residency?
A. Some people who have moved recently are asked to provide documentation of their residency. They have 90 days from when first notified to provide that documentation. Meanwhile, though, insurance that has been paid for will go into effect. As long as you live where you say you do, and make an effort to prove it, any delays or glitches with residency documentation will not cause you to lose insurance, said Lefferts, the spokesman. “We’re going to make sure everyone’s taken care of,” he said.
Will consumers have an opportunity to provide input to the Connector on what it can do better?
A. There is no formal mechanism for doing so. The Connector does not have a consumer advisory board, and there are no seats specifically for consumers on the Connector’s governing board. But Lefferts said the Connector heeds the input it receives through social media, and consumers can also e-mail their suggestions to him at firstname.lastname@example.org.
When is the next open enrollment period?
A. Enrollment for 2016 health coverage is expected to be held in the fall. The exact dates haven’t been set.