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My Wife and I are both American Citizens who got married in October. Our initial plan was to enroll in my job's health coverage during the open enrollment period in November, but after we sat down and looked into our options, we found that its best for both of us to just remain under our parents health coverage (Both of us are under the age of 26, will be until after next year's enrollment period, and our parents are fine with us remaining under their plans as us staying or leaving has zero affect on their plan's cost).

My wife had to submit a renewal form at the end of the year. Flash-forward to the middle of January, the form was sent back due to some missing information. Along came a letter stating that she will need to submit it by the end of a specific deadline(End of January) for them to consider approving us. She filled out the missing information of the form and sent it back, but have not heard word from them since.

She called them earlier today to find that she no longer has coverage. They will not also let her enroll in a plan since: A. It's past the enrollment period B. She does not qualify for special case enrollment.

She does not turn 26 until the next 8 months. We can afford to opt her in any health insurance and have a combined income of >$50K. I am finding our options are limited and am worried she'll be without health insurance until her birthday. Is there any way we can get her set with some sort of health coverage until the next enrollment period?

She does take prescription medication but has run out and has not been able to re-fill due to being without insurance.

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    Regarding the last point, ask the pharmacy what the out of pocket cost would be (explain your situation). My pharmacy prints a "your insurance saved $X" line on the slip. In most of my prescriptions my insurance saves me between $20 and $70. You can decide if it's worth it or not with accurate price information. – user662852 Feb 18 at 18:50
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    Check the special enrollment period (or open enrollment exception) rules for your healthcare plan, loss of healthcare, birth of child, moving, etc. typically enable you to change enrollment. – Hart CO Feb 18 at 19:00
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    Did she return the form by the deadline? – Ben Miller Feb 18 at 19:28
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    "not been able to re-fill". Do you mean you can't afford the prescription out-of-pocket? I'm not aware of any prescription that requires health insurance. – chepner Feb 19 at 14:29
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    What was the specific issue with the renewal? Was it legitimately not submitted in time (postmarked after the deadline is a typical rule, but they can vary), was it submitted but the company is claiming they did not receive it? – Upper_Case Feb 19 at 16:47
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You might investigate getting a short-term policy to cover the gap until the next open enrollment period. My daughter had a situation, possibly similar to yours, where her employer failed to process her enrollment form and then told her that it was too late for her to submit a new one because the open enrollment period was over, i.e. she was out of luck because of their mistake. I talked to my insurance agent and they found a private policy with a relatively late open enrollment period, and in the meantime, for about 2 months, they got her a short-term policy. The short-term policies I've seen generally only cover major expenses, like hospitalization, not prescriptions or routine doctor visits. But they're also priced accordingly. I think they're basically intended for people with "between insurance" situations, like you lost your job and haven't got a new one yet, that sort of thing.

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With regard to the insurance specifically, you don't have many options, and fewer good ones. An important point to bear in mind is that health insurance is not designed to offer any short-term savings-- it is unlikely that buying insurance will be a better deal than paying out-of-pocket for a check-up and prescription fill, though situations certainly vary. The basic landscape:

  • It is unlikely to be the open enrollment period for any typical health insurance plan, and failure to renew definitely does not trigger a special enrollment period.
  • Health insurance that she can enroll in now does exist, but will generally be some combination of: short-term, restricted (i.e., not covering risk to the same degree as an ACA-compliant plan would), and expensive.

So while she can get something called "insurance" you should be very careful about ensuring that it covers her specific medical needs (the regulations that guarantee specific medical benefits to any insurance plan are not guaranteed to apply to any insurance she can enroll in outside of the open enrollment period).

You should also be prepared for the plan to have restrictions (on provider access, covered benefits, unfavorable cost-sharing arrangements, etc.). And you should be prepared for coverage that is more expensive (per benefit received) than what you may be used to. In any case, you will need to talk to insurers or an insurance broker directly to find out much about these types of plans. They are definitely not available through your state's ACA website.

What can we do?

Importantly, this isn't limited to getting insurance (whether or not insurance is effectively required is something I can't answer based on the information provided). If there is an insurance plan that you are certain specifically covers her needs and is affordable, by all means pursue it.

But if there is no such plan, then the issue comes down to the need to get a new prescription written and/or getting the medication.

For the former, you can look for sliding-scale clinics in your area, an urgent care center, or a regular clinic (preferably one that is physician-or-other-provider-owned, as opposed to a big health system) and ask for any discounts they can offer on the cost of a physician visit for a medication check-up or evaluation. Many clinics are sympathetic to people lacking insurance, and many will offer discounts if you are willing to pay for the service upfront. You likely need to ask for this, though.

For getting prescriptions filled, you have that same option (though it's not as common at pharmacies, in my experience). There may also be a price reduction program offered through the company that manufactures the drug she needs, and you can find out about those through a pharmacist or contacting the manufacturer.

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I forgot about Medicaid! Eligibility rules vary wildly by state, so this may or may not be an option for you. Searching for "Medicaid [the state and/or county that you live in]" should be enough to get you started. I don't know enough about where you live (unless it's MN) to give you more specific advice, though.

  • I actually coincidentally do live in MN. Will look into Medicaid – Russ Wilkie Feb 20 at 15:09
  • @RussWilkie MN is relatively generous, and it will mostly come down to your combined income for Medicaid. Your assets may also come into play, depending on if you have children or not. Anyways, the state will try to direct you through the health insurance exchange, MNSure, to apply. Ask if there is any other way you can apply (I'm not sure if they will still accept any other type of application, but there is a good chance they still can). Trying to talk to a person at your county human services office, or DHS, will be your best bet. – Upper_Case Feb 20 at 16:16

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