Insurance Q&A w/ iCan Healthcare Reform Expert, Michael Bertrand

Q: I don’t like my current health insurance and want to switch. I’m being told I can’t right now. Why is that?   Melissa F. – Wilmington, DE

That’s a great question Melissa, and one that we get quite often at iCan.  What you have heard is correct, sort of:  if you currently have comprehensive health insurance – known as “major medical” insurance – you may not be able to change your plan until a new “open enrollment” period begins. 

Open enrollment has long been a feature of employer-based health insurance, and other coverage types such as Medicare Supplemental plans.  Now, with the Affordable Act in place, an Open Enrollment period will also be in effect for those that purchase their own health insurance coverage.  Open Enrollment is when most people will buy coverage, and also when people will have the opportunity to switch their insurance plans.

So, let’s say you were able to get a subsidized major medical plan during the last open enrollment period.  But, perhaps you’re not satisfied with the plan – maybe the provider network is too narrow, or your out-of-pocket costs are too high.  It may be frustrating, but your options are either to keep that plan until the next Open Enrollment period, or stop paying and cancel the policy altogether.  As going without coverage is always risky, my advice would be to hold onto that comprehensive, subsidized insurance until you can find a product that works better for you during the next Open Enrollment period.

But there’s a twist, and maybe it applies to you: If you experience what is known as a “Qualifying Life Event”, you may be able to enroll in a new plan . . . even outside of Open Enrollment!  Examples of life events that would qualify you for a special enrollment include marriage, divorce, birth or adoption of a child.  You also qualify for special enrollment if you lose the coverage you get through your employer, or even if you move to a different state.  A licensed agent should be able to see if you qualify for special enrollment.  If you do, act quickly because your window of opportunity will not last forever!

As a former regulator, people often ask me why there is now Open Enrollment, and why they can’t sign up for comprehensive insurance coverage at any time during the year.  One of the main reasons is because insurance companies don’t want people to wait to get sick or injured before getting health insurance.  Therefore, Open Enrollment is designed to encourage people to make a decision about their health coverage, so it is there for them when they need it.

A final note:  keep in mind that Open Enrollment applies to what are known as ‘major medical” health insurance plans.  There are some types of coverage available year-round, including short-term medical, supplemental plans, and non-insurance programs that may be able to help you control your out-of-pocket medical expenses. 

Michael Bertrand is the Government and Industry Relations Director for the iCan Benefit Group. An attorney by trade, Michael spent several years as an insurance regulator and served as Vermont's Commissioner of Banking, Insurance and Health Care Administration from 2010-2011, wherein he regulated the insurance industry in the state of Vermont and its fourteen (14) hospitals. The information or opinions contained herein are for informational purposes only as a service to the public, and is not legal or tax advice, or a substitute for legal or tax counsel.