Luke Skywalker
Super Moderator
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Daniel Horowitz for NPR
Daniel Horowitz for NPR
We're heading into the home stretch to sign up for insurance under the Affordable Care Act this year. The open enrollment period ends March 31 for most people.
But there are exceptions. And they are the subject of many of our questions this month.
For example, Diane Jennings of Hickory, N.C., has a question about her young adult daughter, who's currently covered on her father's health insurance. "When she ages out of the program this year at 26, in October," Jennings asks, "she'll have to get her own insurance through the exchange. But as she [will have] missed the deadline of March 2014, will she have to pay a penalty?"
There shouldn't be any penalty. Turning 26 is one of those life changes that allows you to buy insurance from the health exchange outside the normal open enrollment period. In this case, since the daughter knows when this will happen, she can make the switch in advance; you can sign up as many as 60 days before you'll need coverage.
This is a function the federal government just recently added to the Healthcare.gov website. When you log into your account there's a new button that's marked 'report a life change.' You click on that button and it should guide you through the process.
Kaitlyn Grana of Los Angeles is also a young adult on a parent's plan – her mother's. She and her husband are expecting a baby in June. Her husband has insurance through his employer. But, she says, "He doesn't really love his insurance, so we're thinking about covering baby through Covered California," the state-run exchange. "My question is, how soon do we need to do this, and what options are available to us?"
We have several questions from young women on their parents' plans who are pregnant. And it's important to know is that while the health law requires that employer health plans cover their workers' young-adult children, that requirement does not extend to their children's children (although a few state laws require it). So Kaitlyn won't be able to get her new baby covered through her mother's plan.
“ While the health law requires that employer health plans cover their workers' young-adult children up to age 26, that requirement does not extend to their children's children.
She can, as she notes, add the baby to her husband's health insurance. Having a baby is one of those life changes that qualifies for your own special open season, at work or through a health exchange. So she and her husband also can buy the baby coverage through California's exchange. But because they have access to the father's plan, they probably won't be eligible for any subsidies to help pay the premiums.
Insurance experts we consulted said the couple can wait until the baby is born to buy coverage, because it will be retroactive, as long as you buy pretty shortly thereafter, usually within the first month.
Staying with the family theme, Lorrie Posegay of Cape Coral, Fla., wonders about a privately-purchased health plan that some of her family members have had for a couple of years now. "So far it's not being canceled," she writes. "But it doesn't meet all the requirements under the ACA. So I'm wondering if we keep this plan will we have to pay a penalty?"
In general, you can't buy new coverage that doesn't include what are called the essential health benefits under the health law. But if you have existing coverage that doesn't include everything, you're probably OK. Especially this year.
Any coverage you have from an employer is considered adequate to avoid a penalty. There's also a one-year extension of privately-purchased plans that don't have all the required benefits. And for the few remaining individual plans that were sold before the law was signed in March 2010, those are considered "