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Q: Can I change my health plan?

A: It depends.

Remember the now infamous quote, "If you like your health plan, you can keep your health plan?" We all discovered that this isn't necessarily true. There are however, situations in which you can change your health plan. These exceptions are called, "Special Enrollment Periods".

If you signed up for an Affordable Care Act (aka: "Obamacare") health plan during the Open enrollment period which ended on March 31, 2014, and you are experiencing "Buyer's Remorse", you most likely will not be able to make any changes until the next enrollment period starts on November 15th this year. Perhaps you signed up for a plan you thought would meet your needs but discovered it was not exactly what you thought it to be. Maybe you did not realize how the deductibles, out of pocket maximums, or drug coverage worked for you, or that you needed to utilize a certain "network" of providers in order to get coverage and discovered not all your doctors participated. I am sorry to say, but you are probably "stuck" in the plan you selected, until next year.

There are, however, certain situations called "Qualifying Events" that will allow you to select a new health plan, if you are affected by any of the following:

  • An employer drops their group health plan, you lose your job, are laid off, have a reduction in hours, exhaust COBRA, death, divorce, legal separation which results in a loss of coverage.

  • You get married; have a birth, or adoption.

  • You move out of Michigan

  • You move to a location that no longer has a participating "network" for your plan.

  • You gain citizenship

  • Your plan is "decertified"

    As I write this article, there are approximately 3,000 persons who will be able to qualify for a Special Enrollment Period. A large insurance company, in Michigan, who has a current Group plan with Blue Cross and Blue Shield, will be cancelling their coverage at the end of July. Those affected by this decision will be able to enroll in a new health plan, without pre-existing limitations for an effective date of August 1, 2014. I wanted to let you know what to expect if you are one of these individuals. First off, you will need to select a "Qualified Health Plan", within 60 days from your loss of coverage. There will be many options for you to select from, and you can pick any company who sells qualified plans. You cannot be denied coverage as long as you make a selection within the 60 day timeframe.

    Do yourself a favor and use some caution! Most of the new plans you will need to select will be significantly different than what you may have been accustomed to. The new plans will utilize "Networks", and you will want to make sure that your doctors participate with these. Look at the breakdown of the benefits, including your co-payments, drug coverage, out of pocket maximums, etc. Premiums vary depending on the plan you select, and should not be your main criteria. You need to be careful in your choice. I would urge you to seek out an independent agent who is knowledgeable and can help you select a plan that will fit your circumstances and has access to all the major carriers.

    I personally, have been working in this field for over 26 years, and represent all the major carriers. Make sure you are getting the service you deserve. The options you have can be confusing. You should feel comfortable with the plan you select and understand what you are purchasing. You may even qualify for a government subsidy to help you pay the cost. A good independent agent can check on this for you. Please feel free to call or e-mail me if you need some assistance, I will be more than happy to give you guidance. You will need to make a selection soon and you will want to make sure you are selecting the program that is best for you.

    Mike Mc Neil is President of M.I.S. of Michigan Inc. and a financial advisor, who has experience working with farm families for over 25 years. He is a licensed insurance agent, who has specialized in estate planning strategies, business continuation, and utilizing "leveraging" financial options. He can be reached at 616 676-1618 or email at mike.mis@sbcglobal.net.

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