This article was written by Keith Black, a health navigator working in Marion and Sumter Counties. In partnership with the WellFlorida Council, Suwannee River has navigators throughout north central Florida to assist individuals in understanding their health coverage options. The navigators are a free, certified, unbiased resource for community members. They cannot make recommendations on plans to choose, but instead explain the various options that exist for you and your family. While open enrollment is over, the navigators are here to assist you year-round.
During open enrollment, Suwannee River AHEC’s health navigators work in nine counties to provide assistance for individuals using the Affordable Care Act’s Marketplace. However, navigators are available post-open enrollment during the special enrollment period (SEP). This runs from February through October and allows consumers to sign up for a Marketplace plan only if they have a qualifying life event. These can be major thing like a change in income, moving, getting married and more. Once a qualifying life event is determined, consumers have a 60-day window (either before or after the event occurs) to complete enrollment. To find out if you qualify to obtain coverage during the SEP, please visit the Marketplace website.
A SRAHEC navigator was recently contacted by a consumer with a dire need for insurance coverage. A referral had be given to the consumer from the local Social Security Office for possible assistance. The husband was covered by Medicare but his spouse age 61 had no coverage. Previously, the couple maintained employer-sponsored insurance, but had lost the coverage last summer. They did not sign up for Affordable Care Act insurance during the open enrollment period as they were unaware of its availability.
The wife had recently suffered a heart attack and after receiving in-patient care at a Georgia hospital, she was released for out-patient care. The couple did not have funds for Cardiac Specialist visits nor for needed prescriptions. The couple went to the Social Security office seeking help to obtain medical care and were referred to a local SRAHEC Navigator. Fortunately, the navigator learned that the couple had moved from Georgia to Florida within the last 60 days. Therefore, they qualified for an SEP under the Affordable Care Act and did not have to wait until open enrollment in November. The Navigator helped the couple enroll for coverage, receive a tax credit and select a Qualifying Health Plan (QHP) that will assist the couple to meet their health care needs.
Moving to a new home is one of the many qualifying events under the Affordable Care Act. Other SEP events include: recent loss of health care benefits, having a baby, divorce, getting married, leaving incarceration (jail or prison), changes in income, and losing eligibility for Medicaid or CHIP.
Along with SEP qualifying events in the Marketplace, coverage is available outside of the Marketplace through private insurance agencies, Medicaid and Florida KidCare (CHIP). Navigators are able to assist consumers in finding these local resources for themselves and their families. The Marketplace will also screen consumers for their eligibility for other options through the “No Wrong Door” policy. This means that when someone applies for either Medicaid, KidCare or Marketplace coverage, they are screened for all three programs and will receive an eligibility letter explaining what programs/discounts they qualify for. For example, a family may not qualify for discounts on the Marketplace, but their children could be eligible for KidCare.
You can see if you qualify for a SEP by going on line at HealthCare.gov, calling the MarketPlace 1-800-318-2596, or contacting a local Health Insurance Marketplace Navigator. Visit our navigator pageto find the contact information for a navigator in your area.