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You Missed Open Enrollment, Now What?

It’s a sinking feeling many people have had — the open enrollment period for health insurance has ended, and they forgot insurance to purchase a plan for the year. If you missed open enrollment and are now in need of a health insurance plan, ClaimLinx is here for you. There are still options out there for employees, and especially employers.  

 

The 2020 Open Enrollment period for the individual marketplace through Healthcare.gov was November 1st, 2019 to December 15, 2020. Some states, especially those that do not use Helathcare.gov have extended enrollment periods, but most finish by the beginning of February. For future reference, Open Enrollment is on the same dates each year, unless specific extensions are made.

If you did not enroll during this time, individuals can still qualify for a Special Enrollment Period with a Qualifying Life Event. Aside from this option, short-term plans are available throughout the year. They are not perfect, but they are a great alternative to having no coverage at all. 

 

Special Enrollment, or a Qualifying Life Event 

Some people may quаlіfу for a ѕресіаl enrollment реriod to ѕіgn uр fоr hеаlth іnѕurаnсе. Certain lіfе еvеntѕ, lіkе lоѕіng hеаlth соvеrаgе, moving, getting married or a change in income can trіggеr a special enrollment period, which lasts up tо 60 dауѕ. Lіfе changes thаt quаlіfу fоr a special еnrоllmеnt реrіоd gеnеrаllу fаll into three саtеgоrіеѕ: сhаngеѕ in thе household, сhаngеѕ in residence оr losing hеаlth іnѕurаnсе.

 

Qualifying сhаngеѕ іn hоuѕеhоld саn іnсludе:

  • Getting mаrrіеd
  • Hаvіng a bаbу оr adopting a child
  • Getting divorced оr legally ѕераrаtеd аnd losing health іnѕurаnсе
  • Hаvіng ѕоmеоnе in your hоuѕеhоld dіе

 

Qualifying changes in residence саn іnсludе:

  • Moving to a new home in a new ZIP соdе оr county
  • Moving tо thе U.S. from a fоrеіgn country
  • If уоu’rе a student, moving to or from the рlасе you attend school
  • If уоu’rе a ѕеаѕоnаl wоrkеr, mоvіng to or frоm thе рlасе уоu lіvе аnd work
  • Moving to or from a ѕhеltеr or trаnѕіtіоnаl hоuѕіng

 

Qualifying lоѕѕеѕ of health аvеrаgе іnсludе:

  • Lоѕіng jоb-bаѕеd соvеrаgе
  • Losing individual hеаlth coverage
  • Lоѕіng eligibility for Mеdісаіd or CHIP
  • Lоѕіng eligibility fоr Medicare
  • Lоѕіng соvеrаgе thrоugh a family mеmbеr

 

Short-Term Health Insurance Plans

These are a special type of plan that can be purchased when a person is between health plans, outside of open enrollment. Short-Term Health Insurance plans provide temporary coverage for certain situations and can be a chance for some coverage in case of emergency. 

Short-term plans come with a wide range of coverages because they are not required to comply with Affordable Care Act (ACA) guidelines. That means they typically include some coverage for preventative care, doctors visits, urgent care and emergency care. It may also have some discounts on prescription drugs. But because it is not an ACA plan, be sure to read the plan limitations before enrolling on a plan. That will tell you what is covered and can help you decide if it’s the right coverage for you. 

You can shop for a short-term plan now by going to the ClaimLinx marketplace. On the site, you can request a quote and someone will reach out to you to talk about your options. 

 

What Happens Without Health Insurance

As of January 1, 2019, there is no tax penalty for not having a health insurance plan. Technically the individual mandate is still in effect but there is no penalty to enforce it. So it may seem to some like going without health insurance is not a big deal. After all, health insurance plans are expensive and if you don’t use many medical services through the year, it can feel like a waste. 

Health insurance is still important to have, for all those unforeseen moments. No one expects to need their insurance plan. People buy it every year because there’s always a chance that an accident, or even a small medical issue, could cause huge financial damage. 

Shop for a health insurance plan at any time at ClaimLinxMarketplace.com. You can purchase short-term plans or, if you qualify for a special enrollment period, you can also take a look at plans through a regular carrier. 

ClaimLinx reclaims thousands of dollars for consumers

Business pioneers strategy for employers to pay less for company health plan

CINCINNATI, Dec. 20, 2018 /PRNewswire/ — As health plan premiums rise nationally, so too do insurance companies’ earnings, but one local business has found a way to return some of those would-be profits to consumers.

ClaimLinx is a consultant, insurance agency and third-party administrator specializing in an alternative strategy for purchasing health insurance that saves companies money while delivering quality benefits.

Nationally, insurance companies reported strong growth in 2018, amassing an estimated $47 billion of global profit by the end of the second quarter, according to an analysis of company documents by Axios media company.

Not all of that money is being funneled into improving care or services. Insurance companies spend only 80 percent of funds collected in plan premiums on actual medical care, as required by the Affordable Care Act.

Packed into those huge premium bills are charges for administration, marketing and company profits for share-holders. That’s thousands of dollars each year being given to insurance companies instead of being spent on what workers really need: quality medical care.

Tom Quigley, National Benefit Consultant at ClaimLinx, says buying traditional health plans leaves a lot of money on the table, an especially difficult prospect for small businesses where profit margins are slim.

“It’s really a shame, because people are really just giving all this money away to health insurance companies without even realizing it.” 

So ClaimLinx abandons traditional methods of purchasing health insurance. Instead, it shows clients how to combine a high deductible plan from a major carrier with a self-funded medical expense reimbursement plan. 

The plan with a major carrier offers a wide physicians network with discounts for services and a stop loss in case of high medical costs. The medical expense reimbursement plan offers the ability to add a lower deductible and better cost-sharing measure for services, like copays.

Christy Quigley, President of ClaimLinx, compares this strategy to other types of coverage.

“People have car insurance, but they don’t buy it for $40 oil changes. Imagine how expensive it would be if it did. We use the same concept for health insurance.” 

This two-prong strategy allows small businesses to restore some of its health care dollars to its employees by delivering better benefits at a much lower price. 

Contact: Whitney Faber, (617) 892-4655
wfaber@claimlinx.com
www.claimlinx.com

View the published release

Another lawsuit aims to take down the Affordable Care Act

A federal judge in Texas heard arguments Wednesday in a case aimed at doing what the Republican Congress has not yet been able to do — dismantle the Affordable Care Act.

The suit hinges on the change to the individual mandate as a part of the tax overhaul President Trump signed into law in December, which zeroed out the requirement that most Americans have health insurance or pay a fine.

The GOP plaintiffs also sought a “preliminary injunction” of the law, which would mean the law would be suspended while the case is decided. The judge has not made a decision on the injunction yet.

Judge Reed O’Connor, a conservative jurist appointed by George W. Bush, heard arguments from GOP plaintiffs, the Justice Department and 17 Democratic attorneys general, with the bulk of his questions going to the defendants of the law.

The lead Democrat arguing the case, California attorney general Xavier Becerra, cautioned against ending the law, even temporarily, as it “would wreak havoc in our health care system.”

The case was filed in February by 18 GOP attorneys general and two GOP governors. They argue the Supreme Court upheld the individual mandate in 2012 as a part of Congress’s authority to tax. Now that the mandate carries no penalty, it can no longer be justified as a tax and should be struck down. And without the mandate, the rest of the law crumbles, including the law’s arguably most popular requirement, that insurers must cover people with pre-existing conditions at no extra cost.

Legal scholars across the political divide believe this is a weak argument, but the case could be the first to go before the more conservative Supreme Court.

Although the Trump administration is technically the defendant in the case, the administration announced in June it would not defend the law. The Justice Department wrote in its filing with the case that it did not think the entire law needed to be eliminated, but it did agree the protections for preexisting conditions should be eliminated January 1, 2019, when the tax penalty goes away.

Filing a case that could put protections for those with pre-existing conditions at risk has already had some political fallout for Republicans, as Democratic candidates have started using it in their campaigns for Congress.

In response, a group of 10 Republican senators introduced legislations last month that prohibits insurance companies from denying coverage or charging more for a pre-existing condition. Democrats point out that the new legislation would not require insurer’s plans to cover treatment for those illnesses, as the Affordable Care Act currently does.

What all of this means is that this is once again a wait-and-see moment for the Affordable Care Act, a daunting concept with open enrollment and an election quickly approaching.

Early 2019 insurance rates highlight a need for benefit alternatives

Inurance Consultant ClaimLinx offers employers a solution for rising health care costs

BOSTONJune 7, 2018 /PRNewswire/ — Insurance premium proposals for 2019 are rolling in this month, so far with requested rate hikes as high as 47 percent in some states. This on top of health care costs outpacing economy-wide inflation for the first time since 2010 forecasts a challenging market for business owners.

Nationwide insurance companies are citing policy changes to the Affordable Care Act, including the repeal of the individual mandate and expanded short term options, as the culprit for the requested higher rates.

Also driving up premiums are medical expenditures. They are expected to rise 2.2 percent this year, compared with 1.9 percent for overall inflation, according to the Center for Medicare and Medicaid Services.

Yet rising prices have done nothing to quell employees’ desire for improving benefits, as they’re now being used as a benchmark in a tightening job market. Employers are going to need alternative benefit solutions to stay competitive with the national unemployment rate dipping to 3.8 percent, according to the Bureau of Labor Statistics.

They’re going to need options like those offered at ClaimLinx, a full-service consultant, insurance agency and third-party administrator that specializes in guiding business owners through the insurance market with its own unique strategy for achieving the best, most affordable health plan.

ClaimLinx has pioneered a solution for purchasing health insurance that combines traditional high deductible insurance plans with a customized self-funded medical expense reimbursement plan. The resulting plan enables employers to offer top-notch benefits at a much lower cost.

Tom Quigley, National Benefits Consultant at ClaimLinx, emphasized that this has to be business owners’ first priority.

“You’ve got to be providing the best assets you can to your employees or it’s going to become your liability — no question,” he said.

What started as a small idea in Cincinnati about cutting costs on health insurance has grown to a nationwide service with offices in Boston and North Conway, NH. In 2017 ClaimLinx helped business owners save an estimated $3.2 million.

John Moore, President of the manufacturing company Ohio Metal Products, changed his company’s benefits plan to the ClaimLinx solution because of increasing costs and even more limited options.

“Our company has saved tens of thousands of dollars,” Moore said. “ClaimLinx can provide the benefits that we want, not what the insurance company suggests.”

Contact: Whitney Faber, (617) 892-4655
wfaber@claimlinx.com
www.claimlinx.com

View the published press release.

Senators to Vote on Republican Healthcare Bill

This week Republican Senators Lindsey Graham, of South Carolina, and Bill Cassidy, of Louisiana, introduced a new healthcare bill aimed at repealing and replacing the Affordable Care Act known as Obamacare.

The Senate is expected to vote on the bill next week, as any repeal and replace bill must be completed and voted on by September 30 in order for it to pass with only a simple majority of 51 votes. 

Related Post: Senate digs into why drug prices are so high

This bill would mean a radical change to the current healthcare system. Here are some of the biggest changes in the bill:

  • Repeals the individual mandate requiring all individuals have health insurance.
  • Repeals the employer mandate requiring all businesses with more than 50 employees to provide an affordable health plan.
  • Allows insurance companies to reinstate lifetime benefit maximums.
  • Allows insurance companies to charge people with preexisting conditions more money for a plan.
  • Requires insurance companies still provide coverage to people with preexisting conditions.
  • Removes the optional Medicaid expansion for each state.
  • Dissolves the federal insurance marketplace known as healthcare.gov.
  • Gets rid of the federal subsidies to help pay insurance premiums for those that cannot afford them.
  • Combines the funds for the Medicaid expansion and insurance subsidies into large block grants given to each state to spend freely to improve healthcare in the state. 

Funding in the form of federal block grants to states would continue until the year 2026, when funding would be cut off. Most harmed by this bill are those states that chose to implement the Medicaid expansion through the ACA. States that did not do this would see a large influx of cash through the federal block grants in the bill. 

Related Post: Senate Republicans Fail to Pass ACA Replacement Bill

Because of the short time frame to vote on the bill the Congressional Budget Office will not be able to provide a full analysis of how this will affect coverage for Americans, though the CBO did say it would release a limited analysis early next week. 

You can see how your state’s funding will be affected in this analysis by the Kaiser Family Foundation.