Commonwealth CHOICE Plans Will Institute
Limited Open Enrollment Periods

 

A new state law limits when individuals and families can buy health insurance. The law applies to private-market, commercial health insurance only, including all Commonwealth Choice plans.  People who want to purchase a commercial health insurance plan will now have two open enrollment periods:  January 1 - February 15 and July 1 - August 15 each year, starting in January 2011.  This law originally was to go into effect on October 1, 2010, but Governor Patrick delayed it to become effective December 1. The Connector will still accept applications on a rolling-basis until then. In other words, if individuals/families do not act before December 1, 2010, their first opportunity to buy health insurance will begin on January 1, 2011.  Then, if they do not then act by February 15, 2011, their next opportunity will begin on July 1, 2011.

Some people may meet special conditions that will allow them to buy health insurance outside of those opportunities, however.  They may qualify if they act within 63 days of losing coverage because they:

• Became ineligible for an employer's plan and do not qualify for another employer's plan or a government-subsidized plan; or
• Became ineligible for their government-subsidized plan and do not have other coverage; or
• Used up all of their COBRA benefits.

The restriction does not apply to government-subsidized insurance like MassHealth or Commonwealth Care.  Employer-sponsored, group health insurance plans are also exempt from the limits.

The intention of this new law is to encourage people to buy insurance rather than waiting until they have a condition that requires treatment.

Background

Commonwealth Choice plans were created to create “group” plans (i.e., more affordable) for individuals and families as part of the state’s 2007 health reform. Plans are offered by NHP, Blue Cross, Harvard Pilgrim, Tufts, and CeltiCare.  These non-subsidized plans, for those with incomes over 300% FPL or otherwise ineligible for Commonwealth CARE, may be purchased either through the Connector or from the insurer.  The individual is responsible for premiums and any cost sharing.  See www.mahealthconnector.org for more details. 

-Adapted from e-mails from Kim Simonion, MPH, Associate Director, Patient Access, Partners HealthCare Community Benefit Programs, and MA Health Care Training Forum Updates of October 3, 2010 and October 18, 2010 (forwarded by Kim Simonian).

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