- Posted by Canopy KC
- On May 3, 2017
- 0 Comments
- ACA Special enrollment period, buy a health insurance plan, choose the right plan, shopping for healthcare.gov plans
By now, the majority of people are familiar with the Affordable Care Act (ACA) that was passed into law in 2014. The ACA states that as a resident of the United States, you can no longer be denied individual health insurance based on pre-existing conditions, gender or age. The ACA also mandates that every resident of the United States must have qualified insurance coverage or face an individual or family tax penalty. Be that as it may, the information provided below is an introduction of what to do if you (think) you have been denied health insurance coverage.
What to do if you’re denied health insurance coverage
· Check the Date! Remember, you cannot be denied health insurance coverage; however, you must enroll or change plans during the open enrollment period. The open enrollment period for 2017 insurance coverage began November 1, 2016, and ended January 31, 2017. The exception to this rule is if you experience a life changing event. These type of events include a change in marital status, change in dependents, change in employment or move to another state. A special enrollment period then opens that allows you to purchase or change an existing plan.
· If you do miss the open enrollment deadline and you have health insurance coverage, you will need to stick with the plan that you have until the following year.
· If you do not currently have coverage and missed the open enrollment period you can still obtain a limited benefits short term insurance plan. Short term plans have modified benefits including prescription coverage, hospital stays, and providers that are covered
· Check your Age! If you are over the age of 26, you can no longer be on your parent’s insurance plan regardless of your student status, employment, or living status. The good news is, a short term plan will be available to you.
· Check the Plan! Did you apply for Medicare prior to turning 65? If so, your application will be denied, but kudos to you for being ahead of the game. You will be able to purchase a short term plan until the following year.
What can be denied:
· As mentioned above, if you attempt to make changes to your existing plan or purchase a new plan outside of the open enrollment deadline (without a qualifying event), you will be denied.
· An individual insurance claim may be denied for multiple reasons. A few of the most common reasons why an insurance claim may be denied are:
a. You did not get pre-authorization.
b. A billing error due to the code associated with your procedure.
c. Treatment was deemed “not medically necessary.”
d. Provider is not in the covered network.
All qualified health plans include the same set of essential health benefits which offer coverage for things like maternity care, emergency care, prescription drugs and wellness/preventative services and are available to everyone. There are multiple carriers, providers and levels of coverage to choose from that affect the amount of your premium, deductible, copay and coinsurance. If you have questions or have been denied coverage (for any reason), give us a call. At Canopy, we make it easy to understand health insurance. Our professional agents are available to you whenever you need because at Canopy: you’re covered.