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Who Can Buy Insurance Now - The Rules

Who Can Buy Insurance Now - The Rules

February 21, 2011

If you need individual insurance, the open enrollment period during which anyone can purchase coverage is over. The enrollment periods only applies to people who buy private health insurance coverage for themselves individually or for their families. It does not apply for those who get health insurance through work, school, or a government insurer such as Medicare, Commonwealth Care or MassHealth.

From now on, the annual open enrollment period for individuals to purchase insurance will be between July 1st and August 15th. Until then, the individual insurance market is in a closed enrollment period.

However, under the following circumstances, individuals may not have to wait until July and may be able to buy insurance during closed enrollment. Here are the rules

1. You can buy coverage if you can answer yes to all of the following questions:

  • Did you have a prior health plan that was terminated less than 63 days ago?
  • Were you terminated for reasons other than you committing a fraud or not paying your premiums?
  • Was that plan a group health plan (including COBRA or mini-COBRA), government health plan (including Commonwealth Care), church plan?
  • Did the plan provide “creditable coverage” as defined in HIPAA (ask your insurer)?
  • Did you have the insurance for 18 months or more?
  • Are you not eligible for coverage under a group health plan, Medicare Part A or B, Medicaid?

2.You can buy coverage if you or your dependent have experienced any of the following events.

  • Marriage (and establishment of domestic partnership, if available under the terms of the policy).
  • Birth of a child.
  • Adoption of a child or placement of that child for adoption.
  • The dependent’s loss of creditable coverage from another group or government plan.
  • Upon court order.

3.You can buy coverage if you experienced any of the following events.

  • Dis-enrolled from individual creditable coverage due to loss of status as a dependent.
  • Dis-enrolled from individual creditable coverage due to the carrier’s termination of the plan.
  • Moved to a place in Massachusetts that is outside the original plan’s service area.
  • Lost eligibility for a qualified student health insurance plan or a Young Adult Health Benefit Plan.

The rules are complex, but the HCFA HelpLine is also available to anyone who needs assistance at 1-800-272-4232.
-Jekkie Kim