6 thoughts on “Was the Nov. 30 Deadline the Make-or-Break Moment for Obamacare? No.

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  2. Open enrollment through the exchanges will be through March. But even after that, is there any reason someone cannot purchase health insurance on the individual market any time they want, same as they might buy term life or auto coverage?

    In that case there would be some contract with the insurer defining the term and specific details of the coverage. Also, in that case they might face some tax penalty for not having been insured “on time” in compliance with the ACA rollout, but after that their coverage should suffice to satisfy the new law. I presume all newly issued health care policies will be required to meet “basic minimum coverage” whether via the exchanges or not.

    Do I have that right?

    • John-

      Plans that have been “grandfathered” (because they existed before March of 2010 when the ACA was passed and have not made major changes to cost-sharing or benefits since then) do not have to follow all the ACA rules that are designed to protect consumers.

      That individual market is likely to shrink. Insurers made money in that market by shunning the sick, not capping deductibles, capping how much they would pay in a given year or over the course of a life-time, and avoiding covering expensive benefits. (The most popular plan in the individual market in New Jersey doesn’t cover chemo. If you’re diagnosed with cancer–too bad.)

      As insurers lose their grandfathered status (because they make changes to the plans) they will flee the individual market.

      There may be private exchanges where an individual could buy insurance — rather than going to the state marketplace–though we don’t know how successful they will be or how well-regulated they will be.

      I hope most people who don’t have employer-sponsored insurance wind up in the govt exchanges where pricing is quite transparent, and the rules really protect the patient.

    • John–

      I am sorry this response is so late. (I responded to your comment and a few others several days ago, but somehow, my replies
      disappeared.)

      After the open enrollment period ends, a person can buy insurance in the individual market outside the Exchanges. Though they should be aware that outside the Exchanges there are no subsidies for middle-income and low-income families.

      Also, those policies will be disappearing. No insurer selling policies outside the Exchanges wants to have to sell coverage
      to someone suffering from a pre-existing condition without charging them far more.

      Under Obamaacare an insurer selling new policies to new customers in the individual market where people buy their own insurance will not be able to charge someone who has just been diagnosed with cancer more. As a result, anyone who is hoping that he will be able to buy le affordab insurance once he becomes sick will be terribly disappointed.
      He will find that policies sold outside the Exchanges will be far more expensive than in the past–because insurers now have
      to cover everyone.

      As a result, the person who has just been diagnosed with cancer might be able to find a policy outside the Exchanges–but it is likely that it will cost far more than an Exchange policy. This is in part because state regulators have to sign off on premiums in the Exchanges and in many states, they have been surprisingly tough.

      People buying their own coverage in the individual market also shouldn’t count on the policy defining specific details of coverage. Outside the Exchanges, policies are not regulated by the government to the same degree.

      The good news is that new policies will be required to meet “basic minimum coverage”– they will have to cover the 10
      essential benefits.

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