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HHS Now Says You Can Sign Up for Health Care After Obamacare Deadline

8:12 AM, Mar 3, 2014 • By JERYL BIER
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Q. I know there's an enrollment period for the health law's insurance marketplaces, but people can also buy a policy directly from a company or agent, outside the marketplaces. So will people be able to buy a regular health insurance policy from a company or agent after March? If so, won't people wait until they're sick or injured to buy insurance? 

A. The open enrollment period, when people can buy an individual plan for 2014 directly through the health insurance marketplace or outside it from an insurer or agent, began in October and runs until the end of March.

The law requires that health plans sold either through the marketplace or outside it be comparable in many ways, including the benefits that are covered and consumer cost-sharing requirements, such as the rule that plans pay at least 60 percent of medical costs. In addition, all plans sold on the individual market, whether through the exchange or outside it, must offer open enrollment during the same time period.  

So there's no easy way to game the system by waiting to buy a plan until you get sick. If you skip open enrollment, you've generally missed your chance to buy coverage for the year unless you have a significant change in circumstance, such as losing your job-based insurance. You'll also face a penalty for not having insurance: $95 or 1 percent of your income in 2014, whichever is greater.

Since the penalty for not having insurance in 2014 is based on lacking coverage for three months or longer during the year, anyone who waits until after March 31 to buy coverage outside the Marketplace will likely incur some penalty, which according to the IRS is "1/12th of the annual payment for each month you (or your dependents) do not have coverage and are not exempt."  Additionally, such individuals will not have access to subsidies as those are available only for policies purchased through the Marketplace.  But the fact remains that even absent the "life events" that are necessary to qualify for Marketplace coverage outside of open enrollment, coverage may be purchased directly from private insurers during that time.  Such offerings, of course, will be up to the individual carriers; CMS's response says that "insurers off the Marketplace may choose to allow" consumers to purchase plans outside of open enrollment, not that they are compelled to do so.

Obviously it would be in the government's interest for the public to assume that no coverage, either inside or outside the Marketplace, may be purchased between April 1 and November 15 unless there is a qualifying "life event."  But as the recent clarification from CMS spells out, the private insurance market (as opposed to "Marketplace") will remain an option for those who for one reason or another resist Obamacare's deadline.

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