Monthly Archives: July 2014

Special Enrollment Periods…Just the Tip of the Iceberg!

Copyright: <a href=''>_fla / 123RF Stock Photo</a>The “open enrollment” period to purchase health insurance in Wisconsin, both on and off the exchange, for 2014 ended April 1, 2014. Under the new Federal Law, the only time an individual can purchase health insurance now is with a special enrollment period (SEP). That’s because medical underwriting no longer exists in the commercial market or on the Federal Marketplace/Exchange.

There are several life events that can trigger a special enrollment: a relocation, marriage, divorce, birth, death, adoption of a child (or foster care), loss of minimum essential coverage, or a change in income. These special enrollments are not easy.  I describe the process as confusing, convoluted and complex (the three C’s).

Each special enrollment for health insurance is “special” because every situation is different. There isn’t a standard SEP. Just like human beings and their DNA, I’m finding out that every SEP has its own set of complexities that the Federal Government is not yet equipped to handle. The Marketplace/Exchange website continues to have glitches, especially in cases of income changes and dependent coverage. Many questions do not make sense to the consumer about current and past coverage. In most instances, the system will automatically override your own desires and move dependents (children) from the health plan directly onto BadgerCare, even if you want to cover them privately.

I forewarn my clients that a special enrollment on the Federal Marketplace/Exchange can take anywhere from one to three hours (or longer). Remember, you aren’t considered covered until you pay your premium. You may also owe a fee (penalty) for the months you did not have coverage in 2014.  In addition, you want to try to be as accurate on your income for the Federal subsidies, because when your taxes are reconciled in 2015 (for the 2014 tax year), you may owe money back.

The next open enrollment period for individual health insurance begins on November 15, 2014 (for a January 1, 2015 effective date). If you want to avoid crashing into an “iceberg”, give us a call (920-955-1040)!   We are Federal Marketplace/Exchange certified and licensed agents with over 40 years of combined health insurance experience.