The Blog

Private Health Insurance, Outside Obamacare Marketplaces, Still for Sale

7:02 AM, Apr 4, 2014 • By JERYL BIER
Widget tooltip
Single Page Print Larger Text Smaller Text Alerts

In the months and weeks leading up to March 31, the Obama administration pushed the message through press releases, tweets and blog posts that the last day in March was the final opportunity to get health insurance in 2014.  A White House blog post on Monday is typical, beginning with the words, "If you don't have health insurance, today is the last day to get coverage that starts in 2014."  Many of the White House's celebrity endorsers proclaimed on Twitter, "TODAY is the Last Day to #GetCovered!" Although exceptions were noted for extraordinary circumstances, certain "life events," and a special extension for those "in line" as of March 31, the impression given was that those who missed the deadline were out of luck.

However, the day after open enrollment for Obamacare ended, the website for Healthcare.gov updated the entry under the topic, "How can I get coverage outside of open enrollment?" A cached version of the page prior to the change speaks of life events, special enrollment periods, and the Medicaid/CHIP options that have no set enrollment period.  The updated page, however, includes much more detail, including a section entitled "Private plans outside the Marketplace."  This page now reveals what we first reported back on March 3: Open enrollment applies only to the marketplaces, not private insurance in general [emphasis in original]:

Private plans outside the Marketplace 

In some limited cases some insurance companies may sell private health plans outside the Marketplace and outside Open Enrollment that count as minimum essential coverage. 

These plans meet all the requirements of the health care law, including covering pre-existing conditions, providing free preventive care, and not capping annual benefits. If you have one of these plans, you won’t have the pay the fee that some people without coverage must pay. 

Insurance companies, agents, brokers, and online health insurance sellers may offer these health plans outside the Marketplace. The Marketplace does not list or offer these plans. You can’t get premium tax credits or lower out-of-pocket costs for plans you buy outside the Marketplace. 

Insurance companies can tell you if a particular plan counts as minimum essential coverage. Each plan’s summary of benefits and coverage also includes this information.

THE WEEKLY STANDARD had contacted the Department of Health and Human Services (HHS) in early March because the original wording on the Healthcare.gov website said, "Outside open enrollment, you can enroll in a private insurance plan only if you have certain life events that give you a special enrollment period." [emphasis added]  After our inquiry, HHS changed the wording to say, "Outside open enrollment, you can enroll in Marketplace insurance only if you have certain life events that give you a special enrollment period."  HHS also provided this statement at the time:

Some insurers off the Marketplace may choose to allow individuals to enroll in a plan at any time provided they comply with new regulations such as not discriminating based a pre-existing condition or current health status. The insurer must also make sure that the plan is available for anyone who may want to purchase it.

Throughout March, however, the Obama administration never explicitly announced this option through its spokespersons or communications, and as reported here, the Healthcare.gov website was not updated until the Marketplace open enrollment period had ended.

It remains to be seen how many insurance companies will take advantage of this opportunity, but as long as the plans conform with the Affordable Care Act, private insurance can be sold at any time. As the new entry at Healthcare.gov notes, those who purchase such plans "won’t have the pay the fee that some people without coverage must pay." (Although presumably someone purchasing such a plan later in 2014 will have to pay a fee for part of the year since lapses in coverage longer than three months are subject to a penalty.)

Since the plans must cover pre-existing conditions just as Marketplace plans, someone who waited to buy coverage and gets sick during the year may still have options, a "loophole" Obamacare was supposed to close.  As with many other claims made by the Obama administration about its signature domestic program, the "last call" for 2014 coverage is not quite as absolute as advertised.

Recent Blog Posts

The Weekly Standard Archives

Browse 19 Years of the Weekly Standard

Old covers