Temporary special enrollment period - Aug. 27 - Nov. 14, 2014

The Washington Health Benefit Exchange (the Exchange), also known as the Washington Healthplanfinder, is making progress to correct the enrollment and payment difficulties that have affected some consumers. Those fixes are continuing, but may take additional time to resolve.

This temporary special enrollment period gives consumers who have struggled with their coverage an opportunity to reset their coverage or select another plan, either inside or outside the Exchange.

This coverage would remain in effect through the end of 2014.

During the temporary special enrollment period, you can:

  • Stay with your health insurer but switch to a plan sold outside of the Exchange,
  • Stay with your current health insurer inside the Exchange, or
  • Switch to a new health insurer inside or outside of the Exchange.

If you move to a new insurer or to the same insurer outside of the Exchange, you must select a plan with the same metal level that you have today.

Of course, you can choose to keep your current health insurer and pay through the Exchange or pay your health insurer directly.

About the special enrollment and who's eligible

Who’s eligible for this temporary special enrollment?

This special enrollment is voluntary and may not be the right choice for everyone. You can qualify for the special enrollment if you have been unable to get or keep coverage through the Exchange because the Exchange made an error in your enrollment, billing, or premium payment since Oct. 1, 2013.

You must make an attestation that you have experienced difficulties and wish to take this option to find new coverage.

If you decide to switch plans you must select a plan with the same metal level of coverage you have today.  

Anyone with Washington Apple Health in not eligible for this temporary special enrollment.

How will health insurers make sure consumers are eligible for this special enrollment?

Each insurance company can set up their own requirements. Most likely, they will ask you to attest or "swear" that you had a plan through the Exchange but are having problems being able to use your coverage. Some insurers may ask you for additional information, such as a print out of your account dashboard with the Exchange or a copy of a premium payment. If you have trouble meeting the insurer's requirements contact our consumer hotline at 1-800-562-6900.

When does this temporary special enrollment take effect?

This temporary special enrollment is effective beginning August 27, 2014.

How long will this temporary special enrollment last?

This special enrollment will last through November 14, 2014, at the latest. The commissioner may decide to end this special enrollment sooner if the Exchange resolves its issues. After November 14, the general open enrollment period for 2015 plans starts and runs through Feb. 15, 2015. During this time, you'll need to either re-enroll in your current plan or select a new plan for 2015.

Who benefits from the temporary special enrollment?

This special-enrollment period will not be right for everyone. Consumers who have and continue to experience difficulty with getting and maintaining their health insurance purchased through the Exchange (Washington Healthplanfinder) could benefit from this temporary special enrollment.

However, if you enroll in a plan outside of the Exchange, you will not get a premium or cost-sharing subsidy, even if you qualify for one. Subsidies are only available for health plans purchased through Washington Healthplanfinder.

How many consumers are currently experiencing difficulty?

The Exchange estimates that 4 percent to 8 percent of current accounts are experiencing difficulty with either enrollment or premium payments. More than 90 percent of the 164,000 consumers signed up through the Exchange were enrolled successfully.

Changing plans

How do I change plans?

First, contact your current insurer to see if you qualify for this special enrollment. You will need to apply for this special enrollment and meet any other requirements the insurer has.

Once you are sure you qualify for coverage outside the Exchange through the special enrollment and understand when your coverage will start, contact the Exchange to disenroll from your current plan. You may continue to get bills from Exchange. If you do not want an Exchange plan, do not pay the bill and contact the Exchange again to confirm that you are disenrolled.

If you need help with this process, contact your insurer directly, an agent or broker, or a navigator in your area.

If you want to change to a different Exchange plan, contact the Washington Healthplanfinder (www.wahealthplanfinder.org).

If I decide to make a change, how soon will coverage take effect?

If you act immediately, you may be able to gain coverage for September 2014. Generally, you must sign up by the 20th of the month to get coverage for the following month, but the insurer may be willing to accept you later this month. Check with your insurer to see when coverage could begin.

If I change plans, can I maintain my current subsidy?

You can maintain your subsidy only if you keep your current plan within the Exchange or change to a different Exchange plan. If you decide to select a plan outside of the Exchange, you will not get a subsidy. Subsidies are not available outside of the Exchange.

What is the "outside market?" Are the plans different?

The outside or private individual market refers to health plans sold outside the Exchange. Some health insurers sell both inside and outside the Exchange; some sell only inside the Exchange; and others sell only outside the Exchange. All plans, either inside or outside the Exchange, must include the same essential health benefits (www.healthcare.gov). However, subsidies are not available for plans sold outside the Exchange, so they may cost you more.

Where can I find another plan?

You can look for another Exchange plan through the Washington Healthplanfinder (www.wahealthplanfinder.org)

Additional health plans are for sale outside the Exchange – either directly from an insurance company or through an agent or broker – but tax credits or subsidies are only available if you buy a plan through the Exchange.

Who can help me find a different plan with the conditions noted under this special enrollment?

Approved insurance agents or brokers can help you find a new health plan. Search for an agent or broker in your area.


Will my co-payments and deductibles be affected?

Yes. If you switch to a health plan outside of the Exchange through this special enrollment, it is very likely that you will lose any credit towards your out-of-pocket maximum or deductible. However, if you stay with the same health insurer, your insurer may let you keep your credit. Ask your insurer before you make the switch. You should carefully consider the financial impact of new co-payment and deductibles if you change to another plan.

What is "direct payment?"

Direct payment is when you pay your insurer directly for your coverage instead of making payments through the Exchange. You have the option to do this any time.

I have made several payments but have received no coverage through the Exchange plan I selected. What happens to that money? Do I get it back?

The Exchange is working with insurers on reconciling these issues. If you cancel your plan with the Exchange, it's possible the Exchange may delete your account, including their records of your enrollment and payments. It's best to keep all of your own records and documents related to your payments and enrollment, to maximize your chances to get your money back.

Metal levels

What is a "metal level?"

How much you'll pay for a health plan depends on the plan you choose. All plans sold in the Washington Healthplanfinder (www.wahealthplanfinder.org) will have different levels of cost-sharing. These are called "metal levels" and include bronze, silver, gold, and platinum.

Health plans sold outside the Washington Healthplanfinder also have the same metal levels to choose from.

The difference between the metal levels is based on how much of the medical costs your health plan picks up and how much you contribute through co-payments and coinsurance for doctor visits, prescription drugs, and other services.

Level Plan pays You pay
Bronze* 60 percent 40 percent
Silver 70 percent 30 percent
Gold 80 percent 20 percent
Platinum 90 percent 10 percent

*Bronze plans have the minimal level of coverage you need to meet the requirement to have health insurance.

How do I know what my metal level is?

Insurance companies are now required to help consumers easily identify cost and coverage levels by categorizing their plans into four metal levels: platinum, gold, silver and bronze. Platinum plans, because they include the most benefits, are the most expensive, while bronze plans are the least expensive.

The bronze-level plans meet the minimum requirements for coverage that individuals are mandated to purchase to avoid a tax penalty.

Updated 11/13/2014

See also

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