Switching Health Insurance Plans - #MedicalBillerExplains Ep. 8

"Roughly one out of five people in the United States switch health insurance on an annual basis. We're here to talk about what Switching Insurance might mean for you and your loved ones. What things should people be aware of when they're switching insurance plans?"

Switching Health Insurance Plans - #MedicalBillerExplains Ep. 8
Photo by Scott Graham / Unsplash

Frederick McNulty: Hey everyone, welcome to the channel. I'm Frederick McNulty, Director of Content at Finestra. In this series, we're asking the most common questions about healthcare in the United States and hearing answers from certified experts.

Amethyst Storey: Hi, I'm Amethyst Storey. I'm a certified professional biller, and I've been in the field for 17 years.

FM: Roughly one out of five people in the United States switch health insurance on an annual basis. We're here to talk about what Switching Insurance might mean for you and your loved ones. What things should people be aware of when they're switching insurance plans?

AS: When switching insurance, you need to be aware that it can only be done during open enrollment, except for in the event of qualifying events. Open enrollment is usually during the fall. It's about six to eight weeks where you can change your insurance for any reason or no reason at all. Just because you don't like your plan, or you found a better plan that better suits your needs, qualifying events to change your insurance during any time of the year would be a loss of employment or healthcare coverage. You get married or divorced. You have a baby or adopted child. Those are all qualifying life events

FM: In terms of qualifying events, you brought up losing one's job. What if this was not a voluntary choice you're fired, you're laid off. Does it make any difference?

AS: There is such a thing as COBRA. If you are laid off or fired from a job, you qualify to be covered by COBRA for up to 18 months. If you can afford it, COBRA coverage is extremely expensive because you're paying for your portion of the bill, as well as the portion that your employer used to pay for it. If you don't qualify for COBRA, you do qualify to switch healthcare coverage on your own

FM: For people who switch insurances. But prior to switching were receiving consistent medical care from a provider, what sort of inconsistencies can occur?

AS: One of the biggest inconsistencies that can occur when you switch insurance is the risk that your provider does not take the new insurance that you decide to go with. In that case, you'll need to contact them to see if you have out-of-network benefits. And if they are taking patients that are out-of-network, or if they would charge you the self pay rate. In addition, if they don't take your insurance, you could always contact them for a referral to a provider that does take your insurance so that you could pay your in network rate.

FM: Are people able to switch insurance if they merely don't like the insurance that they're on?

AS: The only time that you can switch your health insurance, because you don't like the plan that you're on is during open enrollment because not liking your insurance is unfortunately not a qualifying event.

FM: We've mostly been talking about this in terms of individuals choosing health insurance for themselves, but is this different for individuals who have children?

AS: It's actually the same for individuals that have children. The coverage that you pick would either be individual or family coverage. So for example, if you just had a child that would be considered a qualifying event, so you could then change your insurance if you found a better family plan that was more suited to your new family.

FM: You mentioned that giving birth is a qualifying event, but what about people who start families through other ways like adoption or a foster situation

AS: Adopting a child and fostering a child are also both qualifying events. So in the event that you were to find out that you got approved to foster a child, at that point, you could go out and it's treated like open enrollment. When you have a qualifying event, you can, at that time, change your insurance, if you find something that better suits you.

FM: How does this affect people who are going through the naturalization process?

AS: So once you become a U.S. citizen and you've gone through the whole process, that is a qualifying event. And at that time you can switch insurance or get insurance, if you don't already have it.