Arizonans who missed the open enrollment deadline to get health insurance via the Affordable Care Act still have options, albeit limited ones.
The deadline for getting federally subsidized insurance through the public health exchange healthcare.gov was March 31, and open enrollment will not begin again for another five months — on Nov. 15.
While 120,071 Arizonans signed up for insurance via the federal health-care marketplace (also called a health-care exchange) between Oct. 1 and March 31, there are still people without coverage. Prior to Oct. 1, an estimated 1.2 million Arizonans lacked health insurance.
Enroll America (enrollamerica.org), a grassroots group that targets communities with high rates of people without health insurance, has volunteers and staff members in Tucson throughout the summer doing insurance education.
“We plan to be here for a while, at least for the next year or maybe longer,” said Pati Urias, communications lead for Enroll America in Arizona.
Penalties for not having coverage by the federal March 31 deadline may apply in some cases, Urias said, but there are still options for those without insurance:
1. Special enrollment
All insurers must make plans available year-round to anyone eligible for a special enrollment because they’ve had a “qualifying life event.”
Those who qualify may purchase insurance from insurance companies or from healthcare.gov without incurring a penalty. Those with qualifying life events can also get subsidies for the insurance if they qualify.
Qualifying life events include gaining citizenship, leaving incarceration, moving to a new state, certain changes in income and changes in family size for reasons such as marriage, divorce or a new baby.
Also, members of federally recognized tribes and Alaska Native shareholders can enroll in coverage (and get subsidies if they qualify) via the public exchange any time of year, and they can change plans as often as once a month.
The Tempe-based nonprofit health insurance company Meritus is selling Affordable Care Act-compliant plans to Arizonans year-round, though anyone buying the plans outside of the enrollment period, and who does not have a qualifying life event, will not be able to get a federal subsidy.
Arizona Department of Insurance spokeswoman Erin H. Klug says that, to her knowledge, Meritus is the only insurer in the state that is actively marketing outside the enrollment period.
People who choose to go through Meritus to purchase a plan may have to pay a prorated fine, depending upon when they sign up, because of missing the March 31 deadline.
“We’ve had some interest. We believe there are still people who didn’t act during the enrollment period who are still interested in insurance,” Meritus chief executive officer Kathy Oestreich said.
“There are some people who simply did not understand there was a hard cutoff.”
Other consumers thought the open enrollment deadline applied only to people who qualified for subsidies, or they thought the deadline was only for people buying their plans via a government exchange, said officials from eHealthInsurance.com, a private Web-based insurance broker that connects consumers with Affordable Care Act health coverage.
Kris Kraves, a spokeswoman for eHealth, which operates eHealthInsurance.com, says Meritus is the only carrier her company is aware of that will enroll anyone, regardless of the time of year or qualifying event, in an Affordable Care Act-compliant plan.
She noted that in Nevada, all carriers can sell major medical ACA plans without a qualifying life event, albeit with a 90-day wait.
3. Short-term insurance
Short-term policies are attractive to people in the off-season, most likely as a stop-gap solution, eHealth officials say.
The U.S. Department of Health and Human Services does not restrict the sale of such policies, but consumers should be aware that short-term policies do not have to be ACA-compliant — they offer limited protection from costs associated with unforeseen medical events, for a limited period of time.
Such plans also do not exempt consumers from having to pay a penalty for not meeting the March 31 deadline, said Jack Cheevers, a spokesman for the U.S. Centers for Medicare & Medicaid Services. The fines vary according to income level — $95 or 1 percent of adjusted gross income, whichever is greater.
The fine could be several hundred dollars for a family. An individual earning a six-figure income who has no dependent children could owe $1,000 or more — though statistics show it’s rare for someone at that income level to be uninsured.
Short-term plans are less expensive than ACA-compliant policies. The average premium for short-term coverage purchased through eHealth nationwide is $69 for an individual and $160 for a family, compared to $271 for individuals and $667 for families for ACA-compliant plans.
But the plans can have some substantial drawbacks, such as the exclusion of coverage of pre-existing conditions, eHealth officials noted. Most don’t cover maternity costs, either.
Klug of the Arizona Department of Insurance stressed that consumers who buy a short-term medical plan have a 10-day right to return. Consumers who believe that a plan has been misrepresented can file a complaint with the state insurance department.
While there was an enrollment deadline for getting private health insurance through the public exchanges, there are no time restrictions on enrolling in Medicaid, a government insurance program for low-income people. In Arizona, Medicaid is called the Arizona Health Care Cost Containment System (AHCCCS).
The federal marketplace can screen people for Medicaid eligibility. In addition to the 120,071 Arizonans who signed up for health insurance via the federal marketplace between Oct. 1 and March 31, another 101,282 Arizonans were deemed eligible for AHCCCS. The number of Arizonans on AHCCCS has jumped 15 percent in the last year.
Enrollment is currently at 1.5 million, or 23 percent of the state’s population, and local health experts say more state residents are likely eligible but not enrolled.
In order to access federal dollars available through the Affordable Care Act, Arizona expanded its AHCCCS eligibility and restored coverage to childless adults. The threshold is now 133 percent of the federal poverty level or less, which works out to $15,528 per year for an individual or $31,728 for a family of four.
More information is available at www.healthearizonaplus.gov.
5. Small business insurance
Small business owners can offer employee coverage through the federal SHOP (Small Business Health Options Program) marketplace at any time of year if they have 50 or fewer full-time equivalent (FTE) employees. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.
Small employers can claim the Small Business Health Care Tax Credit only for coverage purchased through the SHOP Marketplace. Plans via the marketplace may be purchased through a broker, agent or insurance company.
More information about SHOP is available at healthcare.gov/small-businesses or by calling 1-800-706-7893.
Contact reporter Stephanie Innes at firstname.lastname@example.org