Purchasing insurance coverage isn’t as simple as point-and-click. Sure, you can get on Amazon and buy anything from new shoes, to groceries to bluetooth speakers — instantly. Insurance is a bit more complicated, with a lot more rules. Those rules are meant to protect you. It may seem a bit unfair, but these limitations actually force the marketplace in your favor.
Time For Some History
In the past, insurance providers have been able to exercise their right to deny, deny, deny. If you had any pre-existing conditions, you were out of luck. Now, some people can’t just float by with no medical plan, so they were left with expensive monthly premiums on a HIPAA plan, or nothing. But hey, you can “buy anytime” – that is, if they decide you medically meet-the-guidelines for coverage.
Someone, Open A Window!
Let’s step forward to where we are now. With the creation of the Affordable Care Act (Obamacare), you suddenly lost the ability to “buy anytime.” Feels like they took something away, right? Ok, so what is the trade off for you? The ACA created some fair play rules for the consumer. Let’s take a look at what you get:
You won’t be denied coverage for pre-existing conditions
You won’t be stuck choosing between nothing or an absurdly high monthly premium
You won’t have to worry about predicting the future on health concerns (serious illness, cancer, or injury)
You won’t have to worry about affordability — new subsidies based on income and taxes actually govern your deductibles to mitigate those outlandish premiums
So you can see – the average consumer took away some major wins with the ACA. It’s not so horrible losing that “buy anytime” ability anymore, right? Ok, of course there’s two-sides to every coin.
What’s In It For Them?
You probably guessed that there had to be some give-and-take here. Yes, Obamacare enabled multiple safeguards for you, but they had to give some concession to the providers as well. This is where the Open Enrollment window comes in. Allowing consumers to buy during pre-determined windows, or specific life events, then carriers are able to lower their potential risk. Let’s break these down:
Open Enrollment Windows
These are the windows that new users can enroll into sponsored insurance plans
By locking enrollment to specific timeframes, people can’t just pick up insurance for a major surgery, then drop it afterwards
Pre-existing conditions are now protected. This allows carriers the ability to seem less like the “bad guy,” and give patients the care they need, without the risk.
Providers can dictate what they determine as “Major Life Events”
These events can allow for exceptions on the Open Enrollment window
Exceptions could be:
Having a child
Losing Health Coverage
Yes, some concessions were made, but it wasn’t a total loss as they have new-found protections in place.
A Window of Opportunity
Yes, it may be frustrating that you can’t just log onto a website and grab insurance the same way you rent a movie. In today’s culture of immediacy, we want it – and we want it now. But while Netflix may be able to satisfy your immediate want for an episode of Friends, patience can pay off big when it comes to properly insuring you and your family. As long as you watch for your Open Enrollment windows, and strike when the time is right, you’ll be making stronger, fiscally beneficial choices with your plans.
Robert Seay has been working as a Medicare Broker in St. Louis for 20+ years. Using his experience, he addresses some of the Medicare Misconceptions he encounters, such as:
Should I get the same Medicare as a relative?
Is Medicare coverage alone good enough?
Can I have the same coverage in Medicare as I did at my job?