A Healthy Blog

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

More Stories of Closed Enrollment Crazyness

More Stories of Closed Enrollment Crazyness

October 13, 2011

HCFA received many inquiries from last month’s original open enrollment blog post. We were right – a lot of education on the state’s closed enrollment situation needs to happen, not only for consumers, but also to all players in the health care world. We’ll do our part here by sharing the stories of our HelpLine callers impacted by Please use the comment section to share your experiences, comments, and questions. As always, you can also contact our HelpLine at 1-800-272-4232. Here’s this month’s story:

Jill called the HelpLine excited about starting her new family. She was looking to get a family plan for her soon-to-be family of three. Jill is an expecting mom and covered by her work insurance. Her work only offers individual plans to their employees, so Jill’s husband and baby cannot get coverage through her plan.

Jill’s husband, Dan, lost his Commonwealth Care coverage in May due to Jill’s income putting their household over the limits for coverage. He does not qualify for any of the Massachusetts private health insurance options because he missed the annual open enrollment period, and has been uninsured for more than 63 days. Dan has a diagnosed health condition, so we advised him that he may be able to get coverage through the Federal government’s Pre-Existing Condition Insurance Plan or PCIP. The kicker with the PCIP is that he will have to wait until he has been uninsured for six months or more and get a doctor’s note confirming his pre-existing health condition.

So onto the soon-to-be-born baby… Jill is due in December and wants to know what options will be available for the newborn. We advised her that the baby should be able to get private health insurance outside of open enrollment with a waiver. The baby will need a waiver because s/he will not have technically had had insurance in the past 63 days. Yes, you read that right. The baby, who will have just entered our world, did not have prior insurance so will have to go through a waiver process to get onto a private health insurance plan.

For those of you at home keeping track, we are up to three insurance policies. Jill called us hoping to get a family plan. Jill will not be able to go on Commonwealth Choice with her baby because she has work insurance offered to her. Unfortunately, due to unexpected consequences of the Chapter 288 2010 private health insurance rules, going onto one insurance plan was not an option for her family. There is a fix for this hole. The most immediate fix would be allowing for special circumstances to create a qualifying event in order to go through Commonwealth Choice outside of open enrollment. In this case it would mean allowing for birth to be a qualifying event as to not have a newborn go through a waiver process (which can take 30 days).

-Hannah Frigand