Should I get short-term health insurance?

August 29, 2016 3:46 PM

Hello. Thank you in advance for your help. I have had Kaiser insurance for many years for me and my son. I have been on auto-pay and I guess my auto pay expired and I never re signed up for auto pay so my insurance was canceled. Totally my fault, I get it. I suspect they sent me a million letters but I tend to throw mail away in a haste and probably thought it was junk or just a THIS IS NOT A BILL statement thing. But now what?

I called them and they said that since it was just cancelled in June they could put in a request for reinstatement. They did. I just received a letter that that has been denied. The letter said that "since your account was closed due to nonpayment of dues it is ineligible for reinstatement." OK, fair enough.

Now what though? I have to wait for the Open Enrollment period in November and reapply? I am not experiencing any of the scenarios that qualify for applying outside of Open Enrollment. (I still don't even understand Open Enrollment and why one cannot just apply at any time, but that is another question.)

I live in Oregon. I have seen a psychiatrist on occasion but do not have a major medical issue, nor does my son (4 y/o). We are not low-income and do not qualify for any subsidized assistance.

I panic-googled and found short term health insurance from JCC - "HCC Life Short Term Medical."
Is short term medical insurance a scam or a real thing? Will doctors accept it? What else can I do or is there any other way I can appeal to Kaiser?

Also, for those with Kaiser (which is an HMO), can I still see my Kaiser doctors and just pay nonmember/out of pocket rates?

I feel very irresponsible and stupid right now so please be kind.

posted by click to Health & Fitness (11 answers total)

Best answer: The thing you need to worry about is "catastrophic" health coverage. You can probably pay out of pocket or avoid standard things for the next few months, but if you or your son get diagnosed with a major illness or get in a serious car crash, that can easily and quickly get into the mid-6-figures or higher, and ruined finances for the rest of your life. I'm not sure if the plan you are looking at helps with that - generally they're high deductible plans and not very good for regular maintenance, but will help in the case of disaster. But that's what you need to look into.

(Incidentally, the purpose of Open Enrollment is so that people can't just wait until they need it and then sign up. The idea is everyone needs to be paying for insurance while they're healthy in order for it to be solvent for when people are sick. This is also the reasoning behind the mandate)
posted by brainmouse at 4:00 PM on August 29, 2016 [2 favorites]

It might be worth writing another letter asking to be reinstated. At worst, they say "no" again, but there's a chance they might be willing to reconsider.
posted by Lexica at 4:10 PM on August 29, 2016 [3 favorites]

When you asked to be reinstated, did you tell them you would pay the unpaid dues you owe them?
posted by monotreme at 4:13 PM on August 29, 2016 [1 favorite]

Is this insurance through work? If so, call your HR/benefits people.

If you have an ACA/Obamacare exchange where you are, you can get temporary insurance there (losing your insurance counts as a reason to get new insurance, I think.) You may be able to get Kaiser again, you may be stuck with something else.

Can you see your Kaiser docs and pay a nonmember price: in my experience with Kaiser NorCal, no. They have enough patients, they are OK if you walk. This might differ regionally.

Read the fine print on the short term medical. It might be OK, it might not. I don't know what JCC is.

If your state has an ACA Exchange, there will be a hotline to the "health navigators" who can help you sort out your options. If there is a sliding scale clinic near you, they will have someone on staff who can also help you sort it out.
posted by blnkfrnk at 4:41 PM on August 29, 2016 [1 favorite]

If you have an unpaid balance, pay it, and ask for reinstatement again. Having an unpaid insurance balance for car insurance (ask me how I know -- same situation as you but with car insurance) will put a black mark on your record and make it harder, not impossible, to get insurance through another carrier.
posted by AugustWest at 4:42 PM on August 29, 2016 [1 favorite]

You might try calling a Direct Primary Care clinic. Map

Although DPC is legal under the ACA when combined with catastrophic coverage or an HSA, it is not technically insurance. So, they might be willing to sign you up outside of open enrollment. DPC is on the rise nationwide because it has a good track record of lowering costs while improving patient care.
posted by Michele in California at 4:50 PM on August 29, 2016 [1 favorite]

Best answer: Short-term health insurance is a real thing, but unfortunately it generally not compliant with the ACA because it doesn't provide all of the free preventative care required for complianance. This means that you may be subject to a penalty for the months that you do not have compliant coverage. On the good side, non-compliant insurance is generally cheaper so it makes up for the penalty somewhat.

First off check how long you have missed your payments? The ACA gives you a 90-day grace period from the beginning of your first missed payment.

If you have missed the 90-day grace period, then your only chance of getting ACA compliant insurance is by appealing directly to the ACA exchange for an exemption. Start by contacting one of the exchange navigators which should appear on your exchange web site. You can still work through the exchange even if you are not applying for a subsidy. If the exchange approves you exemption, then they can direct the insurance company to approve as well.

If that doesn't work, then you are stuck buying a short term policy and paying the penalty next April when you file your taxes. You only pay the penalty for the months you didn't have compliant insurance. You can shop online for insurance but it might be better to contact an independent insurance broker in your area by searching online. Independent brokers usually have a better grasp of all the options from various insurance companies and their services are generally free to you because they are paid a commission by the insurance company you sign up with. A good independent broker will try to find you the best insurance for your particular circumstances.

Meanwhile, you can apply for ACA compliant insurance which will take effect January 1. If you like Humana, they can't refuse to take you back if you apply within the nest open enrollment period this Autumn, regardless of your past history.
posted by JackFlash at 5:50 PM on August 29, 2016 [2 favorites]

Response by poster: I really appreciate all the advice. To answer a few questions:

- No, this is not through work. I am a contract employee and am responsible (or not as the case may be) for my own insurance.
- Yes, I paid the balance in full prior to the appeal.
- I just spoke with Kaiser and they said that since 2015 they have been more strict about reinstatement and that unless it is a clear error on behalf of Kaiser, reinstatement is rare.
- Sorry, the "JCC" above is supposed to be HCC. I have no idea what that means either. It was just one of the places that offered short term insurance.

So I screwed myself and my kid. So that is great.

I will look into catastrophic insurance/coverage because yes, that is really what I am looking for, thanks, brainmouse.

Any advice on catastrophic health insurance would be helpful. I really appreciate everyone's time.
posted by click at 6:00 PM on August 29, 2016

Oregon's CHP program for kids doesn't have open enrollment, but it does have income guidelines. I would encourage you to apply, even if you don't think you'll qualify. It may at least provide coverage for him.
posted by anastasiav at 8:55 PM on August 29, 2016

Best answer: So I screwed myself and my kid. So that is great.

Nothing to panic about. You've gotten through eight months of the year so far and you only need to get through the next four.

Regarding open enrollment. The Obama administration has tightened the rules for exceptions because unfortunately too many people were abusing it. They found that people who were given exceptions ran up bills that were 55% higher that people who signed up during open enrollment. This means that people were gaming the system by waiting until they had medical problems to sign up. They also found that people who were given exceptions kept their insurance for an average of only 4 months. This means they were again gaming the system by signing up only when they needed insurance and then cancelling it. So the gamers have ruined things, making it more difficult for someone like you who has had an honest mistake.

But given all that, I strongly encourage you to contact an exchange navigator. They are the only ones who can help provide a waiver that directs the insurance company to re-enroll you. You can make the honest argument that you have been diligently auto-paying your bills for years and that there was an unintentional auto-pay error that caused the gap (did your credit card expire?). You can demonstrate that you were not intentionally trying to game the system and intended to keep you insurance current. There is a reasonable chance that they will be able to help you. Good luck.

But worst case, you can fix everything if you can hold out until January. No insurance company can refuse to sell you insurance if you sign up during open enrollment.
posted by JackFlash at 9:06 PM on August 29, 2016 [4 favorites]

FYI, I saw a post on reddit about Kaiser/auto-pay/cancellations. A LOT of people had the same issue as you and discussed how they resolved it. I will try to find it for you. The reddit post was maybe 2 weeks ago if you also want to try and search.
posted by futz at 11:55 AM on August 31, 2016