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Protecting What Matters Most


What Texas Physicians Need to Know About Finding Affordable Health Insurance After Open Enrollment

On the mind of every Texas physician is the well-being of his or her family, especially regarding their health, health care and having the best coverage in place should it be needed. If you and your family are in need of health insurance but missed the open enrollment period window, which closed on January 1, 2016, know that not all hope is lost. You still have the opportunity to select a health insurance plan if you qualify under a series of life events. If one of these life events has occurred, you could enter a health insurance plan under a special enrollment period.

With a wide variety of qualifying life events available to you, let’s take an cursory look at this extensive list.

Qualifying Life Events That May Allow Obtainment of Post-Open Enrollment Health Coverage

  • - Losing your Medicaid or CHIP eligibility; your current medical plan is being decertified; or your COBRA coverage is expiring.

  • - Significant plan cost or coverage changes.

  • - Your employer terminates its group health insurance plan. 

  • - Marriage, divorce or legal separation resulting in loss of coverage.

  • - Involuntary or voluntary termination of employment.

  • - Death of a policyholder.

  • - Change in your dependency status (e.g. you are a dependent turning 26 years old).

  • - Having or adopting a child, putting a child up for adoption, gaining or losing a dependent.

  • - You, a spouse or dependent are permanently moving to a location with different health insurance options.

  • - Experiencing an enrollment error or your insurance company violated its contract.

  • - Changes in income or household status.

  • - Gained U.S. citizenship or became a legal resident.

If you voluntarily give up your health care plan or you are terminated for failure to pay monthly premiums, you will not be eligible for the special enrollment period.

For more detailed information on these events, including examples of qualifying events, see 26 CFR 1.125-4 and 26 USC § 9801.

While you go through the process with an experienced TMAIT advisor, you will be alerted to the proof needed to demonstrate you have experienced a qualifying life event. These special enrollment periods often last for up to 31 days after the date of your event.

During these 31 days, you have the opportunity to shop for a private health insurance or public exchange plan. You will also have the same plan options available to you that would be available during open enrollment, such as copay plans, health savings account plans, young adult essential plans and possibly dental, vision and short-term insurance plans. It is important to note that plans such as dental and vision can be purchased at any time, even outside of the Open Enrollment period, whether you experience a qualifying life event or not.

What If I Don't Satisfy an qualifying event category?

If you are a Texas physician who missed the Open Enrollment period and you do not fall into any of the above qualifying life event categories, you may want to consider short-term medical insurance as an option to protect you and your family until the next period.

A short-term medical plan can provide coverage for unexpected accidents and illnesses but will not provide coverage for preventative services or meet the individual mandate requirements. This type of coverage can last for a specified period of time, from 30-180 days. Short-term medical insurance is a helpful and affordable option for physicians without a qualifying life event who do not anticipate many health expenses but want some type of health coverage.

At TMAIT, we help Texas physicians find the right medical coverage for their families, even after the Open Enrollment period has ended. Let us help you determine if you fall into a qualifying life event category or a short-term medical plan is the right option for you. Other plans such as dental, vision and critical illness insurance are also available. No matter your situation, an affordable insurance plan is available based on your family’s needs and budget.

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