770-449-7369 / Fax: 770-449-1093 info@cdainc.net

There was a time when the people of the land of US were able to sign up for health insurance any time the mood struck them. There was no requirement to buy insurance, but as prices of healthcare increased dramatically year after year, those who were tuned in recognized the value of the benefit and enrolled.

Unfortunately, the system that allowed enrollment at any time filtered enrollees through an underwriting system which determined who was a good medical risk and who was not. As increasing numbers of individuals could no longer get through the filtering system the question of fairness was raised and the government of the land of US mandated changes in how health insurance would be handled. This law was called ACA and it brought much confusion to an already convoluted system.

New mandates were applied to be sure that more equitable rules would apply while maintaining the open market system of the health insurance industry. One of the main changes implemented was that there would be an annual open enrollment period during which individuals could enroll in health insurance and make any plan changes that they wanted.

The open enrollment restriction was set up to prevent individuals from “gaming the system” by signing up only when they had claims they were about to incur. Since insurance is fundamentally sharing risk with others it would not be fair for someone to take money out of the accumulated pool of money without having contributed to it.

And so WE, the people of US, are limited to enrollment between November 1 and January 31 for the 2016 calendar year. If enrollment is not completed by January 31, which is for a March 1 effective date, no WE can get health insurance until January 1 2017 unless there is one of a few specific situations which produce a Special Enrollment Period.

Yet, I can predict that our office will receive at least a few phone calls after January 31 when some WE are ready to enroll and find they are unable to get into the system. In the past the government of US has created “extra-special” enrollment periods to allow more WE into the system, but unfortunately it would appear that a high percentage of those who waited turned out to be “gamers” as their claims ratios have been quite a bit higher than the WE who played by the rules.

The only hope for the health insurance program in the land of US is that the ACA law and its proponents do not allow it to implode by its generosity, particularly in the enrollment process. Some will get special consideration, but the majority of the WE had better get enrolled by Sunday, January 31 or they will find themselves without coverage until 2017.