Now that we are into the month of February, the Open Enrollment for Affordable Care Act insurance deadline has passed. Your options are currently limited for health insurance. If your employer offers coverage, your OE may differ due to your date of hire. If that door is closed, there is a final option for those who need coverage from today to the OE for Obamacare, which begins on November 1st. Short-term insurance can help those who lack health insurance obtain temporary coverage while in between insurance plans.
What is Short-Term Health Insurance?
Short-term health insurance in Texas is, just as it sounds, temporary health coverage for individuals and families. It is designed to help bridge the gap between losing health care coverage from one source and obtaining it through another. However, it is not as comprehensive as traditional health coverage. It is limited and is not required to abide by ACA guidelines with providing the 10 essential benefits. These can include maternity, preventive care, and prescription drugs. If you require coverage for these types of health issues, STH insurance may not be your best option.
Who Can Apply for Short-Term Health Insurance?
While there are no true guidelines on who may apply for short-term insurance, who is accepted is another story. It is intended as an alternative solution to Affordable Care Act insurance. It is designed for those who are:
- Waiting for Open Enrollment for Obamacare.
- Within a probationary period for an employer-sponsored benefits package.
- Waiting for Medicare benefits.
Short-term health policies are best for those who are healthy. If an applicant has a medical condition, they will most likely be declined coverage. These policies are not treated as they are with Obamacare; they go through an underwriting process and are not guaranteed issued. If you are accepted with an existing medical condition, you will most likely pay an increased premium and have a rider attached that excludes coverage for your condition. Also, if you are healthy when you obtain your policy, then develop a condition, when you come up for renewal, your insurance company may not renew your policy. Depending on how far you are away from Open Enrollment for Obamacare in November, this has the potential to leave you without coverage for a lengthy time.
Am I Able to Enroll in Obamacare If I Lose My Short-Term Health Insurance?
There are a number of reasons one can lose their short-term health insurance in Texas. Since these plans are restrictive and the policies are not guaranteed renewable, it is common for an insurance company to choose not to renew a policy when it comes up for renewal. The reasons for policy denial can be:
Your current medical condition – If during your policy year, you are diagnosed with a health condition that requires regular doctor visits, your insurance company can cancel your short-term health insurance policy when it comes up for renewal.
You failed to reveal medical information – If you deliberately leave off crucial information on your application, the insurance company can deny coverage for a claim and choose not to renew your policy. Your application asks for your history for the past 2-5 years. It is best to be specific and honest. It is better to have a condition excluded and have a policy cover for routine care than to have your entire policy canceled due to failure to disclose information.
So, what happens when you lose your coverage? Will your loss of short-term health insurance in Texas trigger an open enrollment period?
The immediate answer is an unfortunate no. Once you’ve lost your short-term health insurance, it does not give you the ability to enroll in Obamacare. This is because short-term health insurance is not qualified health coverage under the Affordable Care Act. If you lose your coverage because you were denied re-enrollment due to a health condition, then you would need to wait until your Open Enrollment period for Obamacare, which begins on November 1st. Coverage will then begin on January 1 of the following year.
NOTE: In some cases, losing your short-term health insurance can qualify you for an open enrollment period for an employer’s group health plan. Check with your employer for more information.
What are My Options if I Lose My Short-Term Health Coverage?
Being outside the Open Enrollment period for Affordable Care Act insurance, your options will depend on certain factors. Your age and financial status are two that can play into what your next move will be. Both Medicare and Medicaid can be viable options if you meet certain criteria.
Here are the two ways that determine if you are eligible to receive Medicare.
Attained the age of 65: If you are nearing age 65, losing your short-term health insurance may not be that big of a deal because you are nearing your eligibility for Medicare. This form of insurance you generally do not need to apply for. If you qualify, once you turn 65, you will automatically receive benefits for your Part A; part B is optional. Eligibility begins three months before your 65th birthday and continues through three months after your birth date.
Disabled: Medicare will also provide coverage for those with ESRD End Stage Renal Disease or have permanent kidney disease. In these cases, age is not a factor. However, the pay into social security remains a factor.
As mentioned, Part A is automatic. This benefit is available to those who collect social security and have been a legal resident of the U.S. for five years. Part B is optional, as a premium will be attached to it. For 2023 that premium will be $164.90 per month.
If you fall within a lower income bracket, you may qualify to receive free health insurance benefits for a child and adult. The two major factors that will determine coverage will be:
- A child’s age – up to the age of 17 or 18 and attending school.
- Parent’s income – If a parent’s income falls within a certain bracket, you may qualify for the state’s Medicaid program. A parent can be a birth parent, stepparent, caretaker, or relative such as a grandparent, aunt/uncle, sibling, or cousin.
Other considerations, such as U.S. residency, play into an applicant receiving Medicaid.
How Can I Qualify for Affordable Care Act Insurance?
Open enrollment begins November 1 of each year and runs through December 15th. Coverage begins on January 1st. If you missed the deadline, there is a second opportunity. You can enroll by January 15th for a February 1st start date. There are no health qualifications with ACA Insurance as with short-term health insurance. Any health conditions that had been excluded would not count against you, even if you had an STH policy canceled or not renewed due to a health condition.
Options for Health Insurance in Texas
It can be difficult to lose your health insurance coverage when you have a medical condition. When you have short-term health insurance in Texas, it is wise to have an insurance expert on your side. If you have lost your policy or currently have one and a health condition that could leave you without insurance when your renewal approaches, Cover Mile wants to help. Our insurance experts can guide you through your insurance options and the buying process to ensure you have the coverage you need and deserve. Contact us today.