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Massachusetts health care — wonky, with a healthy dose of reality

The Gates Are Closing: Not Much Time Left To Buy Individual Insurance

The Gates Are Closing: Not Much Time Left To Buy Individual Insurance

February 10, 2011

If you need individual insurance, be aware that Massachusetts will close its new limited open enrollment period on February 15th.

The limited open enrollment is a restriction that only applies to people who buy private health insurance coverage for themselves individually or for their families. It doesn’t apply if one gets insurance through work, through school, or through a government insurer such as Medicare, Commonwealth Care or MassHealth.

After February 15th, individuals will only be able to buy private health insurance during the Open Enrollment Period each year. The Open Enrollment Period will last for six weeks during the summer, from July 1st to August 15th. You will not be able to buy private insurance at any other time of year unless a special exception applies to you.

This time restrictions on purchasing coverage was part of the 2010 insurance law, chapter 288. The theory was that allowing anyone to buy and drop insurance at any time creates gaming opportunities that drive the cost of health insurance up for everyone. A study found a 1%-2% increase in premiums due to short-term coverage.

What this means is that people without insurance must buy coverage before February 15th, or wait – without health insurance! – until July. Exceptions are made for some of the most common reasons people will need to buy new or more insurance during the middle of the year. Losing your job, having/adopting a baby, and leaving school all qualify. (But you can’t wait forever after something like this happens; you have to apply for new insurance within 63 days.) DPH’s Office of Patient Protection can provide waivers if one demonstrates that he or she did not deliberately avoid enrolling in coverage.

The Health Connector and Division of Insurance are good sources of information on the eligibility rules. The Connector plans to have an interactive web tool to assist people in figuring out eligibility exceptions.

The HCFA HelpLine is also available to anyone who needs assistance at 1-800-272-4232.
-Karen Marcus