Kreidler announces limited special enrollment period for people struggling with health coverage

For the Reporter

Insurance Commissioner Mike Kreidler announced a limited special enrollment period – effective Aug. 27 – for people who have experienced difficulty enrolling in health coverage through Washington’s Exchange, Washington Healthplanfinder, or who have had billing or payment issues.

The special enrollment period starts Aug. 27 and is scheduled to run through Nov. 14. Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

General open enrollment for 2015 individual and family coverage starts Nov. 15, 2014 and ends Feb. 15, 2015.

“The Exchange is making real progress in reconciling the cases of those consumers who’ve experienced ongoing claims and payment issues,” said Kreidler. “Today’s announcement should not take away from their efforts. It’s just one more option for consumers who still need coverage. It will not be the best option for everyone, but hopefully it’ll bring immediate relief to some.”

Consumers who choose to leave the Exchange and switch to a health plan sold outside of the Exchange will lose their premium and cost-sharing subsidies. Consumers may also lose any credit toward their cost-sharing deductible or out-of-pocket maximum.

During this limited special enrollment period, if you have experienced difficulty getting or keeping health coverage through the Exchange, you can:

• Stay with your health insurer inside the Exchange, but “reset” your coverage (you may lose any credit toward your deductible or out-of-pocket maximum)

• Stay with your health insurer but switch to a plan sold outside of the Exchange (you will lose your subsidy)

• Switch to a new health insurer outside of the Exchange (you will lose your subsidy)

• Switch to a different insurer inside the Exchange (your subsidy amount may change)

If you decide to change your coverage – either inside or outside of the Exchange, you must select a plan with the same “metal level” that you have today. Metal level refers to the type of coverage and cost-sharing requirements.

A list of answers to questions about this temporary special enrollment is available on the insurance commissioner’s website.

Consumers still have the option to keep their current health insurer and pay through the Exchange or pay their premium directly to their health insurer.

Who’s eligible?

Anyone who has been unable to get or keep coverage in a plan through the Exchange because of an error in their enrollment, bill, or premium payment.

People with Washington Apple Health are not eligible for this temporary special enrollment period.

How will this help?

This is an option for consumers who have experienced difficulties with their health coverage over the last several months. It will not be the best option for everyone.

Approximately 85 percent of people enrolled in a plan through the Exchange receive premium or cost-sharing subsidies. If they move to a plan sold outside of the Exchange, they will not be able to keep their subsidy.

Everyone must re-enroll or select a new plan for 2015 during the general open enrollment period, Nov. 15, 2014 – Feb. 15, 2015, even people who use the special enrollment to change plans now

“I’ve created this special enrollment period in direct response to consumer complaints I’ve heard over the last several months,” said Kreidler. “I continue to support the Exchange and the work it has done to successfully enroll over 90 percent of the people who applied for coverage through Washington Healthplanfinder. They are dedicated to solving these technical issues and they are making progress. But as insurance commissioner, it’s my responsibility to do what I can to give consumers as many options as possible for getting coverage.”