Health insurance enrollment periods

THE government is more lenient to people with low-incomes and assets in the sense that they can get Medicaid (Medi-Cal in California) anytime of the year. That leniency to get Medi-Cal anytime is even more obvious to children and pregnant women whose household income is not more than 266 percent of the Federal Poverty Level (FPL) for children or 322 percent for the pregnant women. As an example, for a family of three, the 2016 FPL is $20,159. So if the household income is not more than $53,625, the children can get Medi-Cal. If not more than $64,915, the pregnant family member can also get Medi-Cal.

Other health insurance programs have enrollment periods, such as initial, open and special enrollment periods.

A company can offer group insurance anytime of the year to its employees, but once past the initial enrollment, the existing employees cannot get it anytime until the renewal time known as open enrollment again, which occurs a year later. After initial or open enrollment, typically only new hires can be enrolled.

Both Covered California and off-exchange (direct) individual health insurance are not available anytime of the year. When the open enrollment started and ended have been different in the last few years. For this year, open enrollment ended on Feb. 6, 2016. But those who have qualifying event after Feb. 6 can still apply.

A typical scenario would be that somebody lost or is losing health insurance after Feb. 6, but not due to non-payment of premium. This qualifying event during the special enrollment period allows for enrollment within 60 days the event happened. Another event would be somebody who just moved into or within California. Or a newborn baby can also get insurance beyond Feb. 6. Or somebody who just got married. How about people who just gained legal presence? Or those recently freed from incarceration? They can get health insurance outside of the open enrollment.

People who are offered Medicare for medical reasons and those 65 and over wanting Medicare have to follow Medicare enrollment periods. Typically, seniors have 7 months initial enrollment period, which starts from 3 months before his 65th birth date month and ends three months after his birth date month. If they don’t get it, they have to wait for the Medicare Part A or Part B open enrollment, which happens between Jan 1 to March 31 yearly. Outside of the initial or open enrollment period, a qualifying event is needed for the senior to have this special enrollment into Medicare. An example is a senior who losing his group insurance. Or another event is a senior who has just recently fulfill his five years of legal stay.

Seniors, who are with Medicare Part D for drugs, or who are with Medicare Advantage or Part C, have the right of changing their Medicare plans yearly during their open enrollment period, which is between Oct. 15 and Dec. 7 yearly. Outside that period, change plan is only possible with valid exemption. For example, a person with low income or Medi-Cal can do it; a person who just moved to another county; or a person who have certain chronic illness. How about a person staying in an institution? Or someone who was just freed from jail? They all have the right to switch or get a Medicare plan.

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If you have more questions regarding the enrollment periods or other insurance questions, feel free to ask the author for answers. A good telephone number to reach him is 855-955-1800. You can also check out

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