Coverage Options Mid-year?

[kvlamb]

I am hoping someone who understands our new system of healthcare better than I do can help me understand my situation.

In 2014 my wife and I qualified for Medi-cal, received the benefits ID card, and were waiting on medi-cal paperwork to come in the mail. Unfortunately, that paperwork never came, so around the end of the enrollment period this year, I went online again, and found that we no longer qualified for medi-cal, (we graduated college and got jobs). Then, after a number of attempts to enroll and lots of technical difficulties, I gave up (my first mistake, I know) on trying to enroll in state funded health insurance and figured I would go out on the insurance market and get us low-premium/high-deductible plan.

Since then I have spent the last few months trying to shop for insurance online, only get more and more frustrated because I am constantly redirected to the state health insurance website and am told I can't enroll in health insurance outside of the enrollment period. Today, I came across an option for short term coverage, but it excludes pre-existing conditions (and my wife may be pregnant, which I believe is typically considered a pre-existing condition).

What are my options at this point? Can I argue my loss of medi-cal eligibility as a life changing event? Or have I waited too long? And why can't I seem to shop for insurance on an open market? Does the state/federal gov't control all insurance plans now?...

Thanks in advance for any help

 

[taterpeeler]

sounds like you are out of luck for 2015... i suggest that you deal with an agent for the next enrollment. Obamacare is not a DIY type thing, regardless what Obama says.

In regards to the STMM won't cover nor approve you for coverage with some pre-x meaning prego.

 

[Yagents]

Yes, the government now controls the distribution of health care. It tells you what, when and how to buy.

You may qualify for Medicaid in your state if your pregnant. Feel lucky you can get coverage in January before baby delivery.

Or, quit your job and get on the Medicaid dole. Your college degree is useless in the new amerika.

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Enjoy that penalty too for not having coverage.
Vote accordingly

 

[taterpeeler]

Yes, the government now controls the distribution of health care. It tells you what, when and how to buy.

You may qualify for Medicaid in your state if your pregnant. Feel lucky you can get coverage in January before baby delivery.

Or, quit your job and get on the Medicaid dole. Your college degree is useless in the new amerika.

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Enjoy that penalty too for not having coverage.
Vote accordingly

and vote often and remember that them dems still love this law.... facts are you are uninsured and prego..... who caused that?...... you didn't use an agent, who caused that?...... I'm self employed and i built my company

 

[jlallgier]

Give this a shot it might work. Best of luck to you.

Here are some special enrollment periods you might qualify for

http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/

800) 300-1506 and speak to a Service Center representative.

Other qualifying life event
Examples:

You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions.
Misconduct or misinformation occurred during your enrollment, including: An agent, enrollment counselor, Service Center representative or other authorized representative enrolled you in a plan that you did not want to enroll in, failed to enroll you in any plan or failed to calculate premium assistance for which you were eligible.
Eligibility for COBRA coverage: If you become eligible for COBRA coverage due to the loss of employer-sponsored insurance, you can choose coverage under COBRA, or you can use a special enrollment period to enroll in a Covered California plan.
Misrepresentation or erroneous enrollment, including:

Incorrect eligibility determination. This includes if you applied during open enrollment and were initially told you were eligible for Medi-Cal and then later determined not to be eligible for Medi-Cal.

The health plan did not receive your information due to technical issues.

An error in processing your immigration documents resulted in an incorrect eligibility result.

Incorrect plan data were displayed when you selected a plan: Data errors on premiums, benefits or copay/deductibles were displayed; incorrect plans were displayed; or a family could not enroll together in a single plan.
Your health plan violated its contract.
Exceptional circumstances occurred on or around plan selection deadlines, including natural disasters and medical emergencies.
You received a certificate of exemption for hardship from Health and Human Services for a month or months during the coverage year but lost eligibility for the hardship exemption outside of an open enrollment period.
You are required by court order to provide health insurance for a child who was been determined ineligible for Medi-Cal and CHIP, even if you are not the party who expects to claim the child as a tax dependent.
You are a member of AmeriCorps/VISTA/National Civilian Community Corps:
If you entered AmeriCorps or one of the other organizations listed above outside of open enrollment.
If you ended your service with one of the organizations listed above.
You have a “grandfathered” health insurance plan outside of Covered California, and you would like to switch to a Covered California health insurance plan instead of renewing your current plan.
Your provider left the health plan network while you were receiving care for one of the following conditions:

- Pregnancy.
- Terminal illness.
- An acute condition.
- A serious chronic condition.
- The care of a newborn child between birth and age 36 months.
- A surgery or other procedure that will occur within 180 days of the termination or start date.
You were released from jail or prison.

 

[Dave020]

Depending on your combined income, your wife may qualify for MCAP program (formerly AIM) through Medi-Cal once determined pregnant.

AIM Program - MCAP - Medi-Cal Access Program

 

[OregonDave]

Edit: In response to Dave020 the income limits to get on Medicaid in CA for expectant families is really high, if you haven't applied as-pregnant and she is, then you should review that option. Medicaid can be applied for at any time outside open enrollment. Barring that...

Moving to a new state would activate a special enrollment period. Depending on Covered California's rules you may not have to wait too long to move back either. If you've thought about moving at all this reason could be the tipping point.