Is Obamacare to blame for the 'Open Enrollment Period'

I’m struggling to get individual health insurance in California because due to a complicated series of circumstances related to moving here from another country I wasn’t given a social security number (necessary to apply for insurance) during the ‘Open Enrollment Period’. Now that I’m ready to get health insurance it’s rather difficult because by default no providers are allowed to accept my application outside of the magic ‘open enrollment period’ unless I fall into one of a few specific exceptional situations (when I apply I will be arguing that one of them does apply to me but that’s unrelated to my question).

My GQ is: before the Affordable Care Act, could people apply for individual health insurance plans at any time of the year or was there always some sort of ‘enrollment period’ during which one needed to apply?

If Obama is responsible for this dumb enrollment period it does sour my view slightly on the ACA.

Whenever I had health insurance through work there was an open enrollment period in which I could make any changes to my coverage.

Outside of the period I could buy or change insurance when I was first hired, if we had a major life event (like getting married, divorce, had a child, or if we lost coverage from somewhere else etc), or a few other exceptions. Once I wanted to pick up dental insurance but missed the open enrollment period and could not. This was years ago.

The open enrollment period has been around as long as I’ve be employed, going on 20+ years.

However I do not know about being able to buy insurance privately (not through work) and how that was done.

Moderating

Let’s keep political commentary out of this thread. Your use of “blame” in the title tends to poison the well also.

Keep responses strictly to the narrow question of what the procedure was before passage of the ACA, NOT who is to blame for any limitations in the policy.

Colibri
General Questions Moderator

Open enrollment is needed when there are not pre-existing conditions clauses. Most employers only let you pick your plans during a certain time of the year even before the ACA.

If you could sign up at any time, you could do without insurance until you needed an expensive procedure. Even if you had to pay a penalty, often that penalty would be less than what your treatment would cost.

Pre-ACA, insurance could have lengthy exclusions for pre-existing conditions, so they were happy to let you sign up at any time. They would just say they would only cover future illnesses. If you were currently ill, they wouldn’t cover care for whatever that was. So if you had cancer when you signed up, they wouldn’t cover it.

Welcome to America :slight_smile:

One of the problems with “buy me!” health care is that perhaps some (many?) people would only buy it when they needed it. Add in “no discrimination against pre-existing conditions” (a proviso of the ACA) and it makes it difficult to prevent people from only enrolling when they absolutely had to. Then, the vast majority of those with health care would be those who needed it badly enough that the premiums would be cheaper than directly paying the bills. So, the simple solution that was devised was to limit enrollment to specific times. If you didn’t buy health care this month, you wait 11 more until it’s available again. They may have taken the idea as mentioned above from the same concept that was used before ACA - you had to change your coverage during a specific window, you couldn’t just make the change when you needed the extra coverage.

Another example of an Open Enrollment period is found in Medicare.

Typically one signs up at age 65 (or when you retire) but there is a 7week period that begins every October. At this time you can change your drug and supplemental insurance policies.

“Open Enrolement” has been around a LONG time. WAAAAAY before the ACA.
In very simple terms, government or employer-provided health insurance worked like this: You get access after a ‘vetting’ period after initial employment, the duration of which is based on the contract the government/employer has with the insurance company. After that, any changes to your health insurance options were locked except for during Open Enrolement, or due to specified “life changes or events” i.e. marriage, addition of new members to the family, etc.

I agree with you and maybe the word’ blame ’ should be removed the title too.

As others noted, prior to the PPACA (formal name for Obamacare) open enrollment periods applied to group plans. Usually these were employer sponsored plans.

If you did not have an opportunity to buy coverage as a part of a group plan then you could still try to buy coverage with an Individual Plan. Prior to the PPACA the insurance companies could medically underwrite policies. This means they could decide to limit or exclude coverage for any pre-existing condition; they could charge you more for coverage; or they could deny you coverage at all if they felt you were likely to need a lot of costly medical treatment.

One more important point, prior to the PPACA you could not be denied coverage for pre-existing conditions if you moved from one group plan to another and did not have a lengthy gap in coverage.
Once the PPACA passed insurers could no longer medically underwrite policies. They had to accept all applicants and cover any pre-existing conditions. To keep people from going without insurance and then buying coverage only if and when they are faced with costly medical bills the PPACA generally requires you to buy coverage during an Open Enrollment Period.

If you just moved to the United States that should trigger a “Special Enrollment Period” allowing you to buy a policy outside of the open enrollment period. Several major life events trigger such Special Enrollment Periods. Here is more about that from the government’s webpage on the topic.

Yea. Short answer:

“Is Obamacare to blame for the 'Open Enrollment Period?”

NO.

This was a very informative thread. I had no idea there were so many logical reasons for the open-enrollment period. I definitely learned a few things today, thank you everybody.

In the individual market the answer is yes. I bought individual insurance when I was younger before Obamacare and did not have to wait at all.

As has been explained upthread, that’s because when you were younger you could purchase a policy without waiting IF AND ONLY IF you passed medical underwriting and subject to pre-existing conditions. Now, you have to wait, but they can’t deny you based on your medical history.

(Per Kaiser, more than a quarter of Americans are likely uninsurable under the medical underwriting standards prevailing prior to the ACA, so they had no chance to buy any policy. The rest of us could buy one, but it could all kinds of exclusions that don’t exist today. You’re comparing apples and kumquats.)