Health Insurance - Can I not switch plans outside of 'open enrollment'?

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Jeeebus

Jeeebus

Diamond Member
Aug 29, 2006
9,181
901
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Umm I thought I was supposed to have more freedom/choices with this revamped health system of ours.

Have an individual plan (purchased through the exchange) that is platinum in name only - it sucks donkey ass on a humid day. Basically I have the benefit of paying $1200/mo for a plan that no doctors in the area seem to take.

Ok no problem - let me just go online and switch to something else. Sorry sucker, you're stuck with it until the next open enrollment period. Want to sign up for a short term plan that is twice as pricey and doesn't cover pre-existing conditions, click here!

Is this right? Are we no longer able to shop health plans freely whenever/wherever we want? Don't want this to be political - just want health coverage that doesn't suck as bad as episodes 3 - 8 of a Walking Dead season.
 
J

jaha2000

Senior member
Jul 28, 2008
949
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Only if you have a qulified change of life.. Aka, get married, have a kid, new job ect.
Your stuck.. Good luck...
 
gorcorps

gorcorps

aka Brandon
Jul 18, 2004
30,741
456
126
Nope, you get a 3 month window every year to make changes. Not sure exactly why but that's it.
 
Jeeebus

Jeeebus

Diamond Member
Aug 29, 2006
9,181
901
126
waggy said:
hahahahahah you thought you had a choice? so cute.
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Not only that, but the cost savings are amazing! I get to pay 3x what I was paying as an employee AND get shittier coverage/less options.
 
NikolaeVarius

NikolaeVarius

Lifer
Oct 25, 2006
11,036
11
91
gorcorps said:
Nope, you get a 3 month window every year to make changes. Not sure exactly why but that's it.
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It's so that you can't use the cheapest health insurance 99% of the time and then when you get sick/get injured you switch to a expensive insurance on the fly
 
Kyle

Kyle

Diamond Member
Oct 14, 1999
4,146
11
91
It's been that way for me at least for the last 15+ years - open enrollment or qualifying life event only. Doesn't make a lot of sense, but not really a new system/process.
 
gorcorps

gorcorps

aka Brandon
Jul 18, 2004
30,741
456
126
BarkingGhostar said:
Three months, really? My employer has ~250,000 employees and we get 2 weeks.
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Well... the government has a 3 month window I belive. If you're going through your employer then they'll have their own rules. Since the OP got his individually I think he gets the full 3 months (Nov-Feb).
 
gorcorps

gorcorps

aka Brandon
Jul 18, 2004
30,741
456
126
NikolaeVarius said:
It's so that you can't use the cheapest health insurance 99% of the time and then when you get sick/get injured you switch to a expensive insurance on the fly
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I figured the "no pre-existing conditions" would take care of that, but I guess it's hard to tell what conditions somebody has.
 
DrPizza

DrPizza

Administrator Elite Member Goat Whisperer
Mar 5, 2001
49,601
167
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www.slatebrookfarm.com
Jeeebus said:
Not only that, but the cost savings are amazing! I get to pay 3x what I was paying as an employee AND get shittier coverage/less options.
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Wow, between my employer and I, it's about the same cost per month as you're paying. $2 copays for most prescriptions (I don't even know what triggers the higher $20 copay), $10 copay for office visits, many office visits (annual check-up, various screenings, etc.) are free. I think it's $100 for ER unless you're admitted. No deductible limits to hit.

As I understand it, it's a pooled insurance - a large group of employers are self-insured, but the insurance is administrated by one of the larger insurance companies.

That should give a rough estimate of what it would cost if we went to single payer in the country. So many middle men, trying to take a cut, shareholders to pay, CEOs to pay, etc. that your $1200/month doesn't come close to covering what my $1200/month gets.

Kyle said:
It's been that way for me at least for the last 15+ years - open enrollment or qualifying life event only. Doesn't make a lot of sense, but not really a new system/process.
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If you could change your insurance plan all willy-nilly, people would game the system, which doesn't work for pooled risk. E.g., uh oh, this feels like a lump in my breast. Let's change insurance to the cadillac plan that covers breast cancer 110%, then tomorrow I'll go to the doctor. Oh, false alarm - let's change back to the cheaper plan.
zinfamous said:
Hey, at least you are fortunate enough to have access to an HSA, no?

http://www.madfientist.com/ultimate-retirement-account/
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Heh! My wife just found out this weekend that I have an HSA - my sister was talking about hers, and because of similar employers, my sister knew I had one. My wife asked, "uh, how much money is in there?" "Plenty." I like that it rolls over. I could cover $2 each month for a prescription, or a $20 pair of glasses from Zenni with it. Or, gee, instead of $20 at Zenni, let's splurge and get a $400 pair locally. OR, save the money in case one day, one of us gets really sick.
 
Indus

Indus

Lifer
May 11, 2002
16,468
11,326
136
You can change starting in November or with a life changing event.

I managed to change because my insurance company recently because I got married.
 
dullard

dullard

Elite Member
May 21, 2001
26,120
4,771
126
Jeeebus said:
Have an individual plan (purchased through the exchange) that is platinum in name only - it sucks donkey ass on a humid day. Basically I have the benefit of paying $1200/mo for a plan that no doctors in the area seem to take.

Is this right? Are we no longer able to shop health plans freely whenever/wherever we want?
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You can freely choose once per year, and you did freely choose. You happened to have unknowingly chosen poorly for your situation.

We can't have private insurance and complete freedom of when to buy what. Otherwise, people will choose the nearly free insurance, get sick, then freely choose the very expensive insurance until they are healthy, then freely choose the cheap insurance again. That just isn't practical as long as profits need to be maintained in the system.

So, the compromise is that you get to freely choose once per year (or whenever you have one of the pre-defined major life experiences such as getting married or having a child).

Oh, and in most cases, platinum is platinum for the insurance companies (money in their pocket) and not for the customers.
 
dullard

dullard

Elite Member
May 21, 2001
26,120
4,771
126
DrPizza said:
Heh! My wife just found out this weekend that I have an HSA - my sister was talking about hers, and because of similar employers, my sister knew I had one. My wife asked, "uh, how much money is in there?" "Plenty." I like that it rolls over. I could cover $2 each month for a prescription, or a $20 pair of glasses from Zenni with it. Or, gee, instead of $20 at Zenni, let's splurge and get a $400 pair locally. OR, save the money in case one day, one of us gets really sick.
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I strongly encourage you to game the system. HSAs are the best legal tax dodge in the US at the moment. Milk it. And that means put the max in you can and then get your $20 Zenni glasses with out-of-pocket cash.
 
brianmanahan

brianmanahan

Lifer
Sep 2, 2006
24,638
6,016
136
umm, employer health insurance has never worked that way. any changes have to be made with a life event or during open enrollment.
 
Y

yuchai

Senior member
Aug 24, 2004
980
2
76
Just to set the record straight. Platinum refers to the actuarial value of the plan. Basically it's the % of total eligible claims that the plan will pay ON AVERAGE for the entire pool of people in the plan. This is completely based on the plan design features such as deductibles, copays, coinsurance, etc. A platinum plan has to pay at least 90% of overall eligible claims. Note that because that is a really rich plan, those plans typically attract the sickest people in the market and are priced accordingly. Usually you're better off in Gold or Silver plans unless you are very sick.

The metallic tier of the plan has nothing to do with the choice of providers. It is completely based on the plan design features.

You really should have done your research in terms of the network providers (especially if you're not in a big city like NYC where there is a lot of choice anyway) before choosing a plan. Provider choice is based on the insurance company, and also the network they are offering with the plan. You can typically look up provider directories with the plan choices before making an election.

Like others said, you have never been able to make mid-year plan election changes without a qualifying event. This has not changed as a result of Obamacare. This will never change because of the anti-selection issues that others mentioned in the thread.
 
TheGardener

TheGardener

Golden Member
Jul 19, 2014
1,945
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When it comes to you getting the government you deserve or voted for, what choice did you have? Obamacare or Romneycare? Obama has openly said that Obamacare was based on Romneycare.

While you wrote what your monthly payment was, you didn't mention what your deductible is?
 
balloonshark

balloonshark

Diamond Member
Jun 5, 2008
7,199
3,652
136
Medicare Part D prescription drug coverage is the same way. You can only change plans during the enrollment period unless you qualify for "extra help".
 
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