I am not lying, it is not a family member or friend…just curiosity! If a family with no insurance,for whatever reason, has no insurance, a member of the family suffers a catastrophic medical emergency, can that family sign up for obamacare? If so, do they pay a hefty fine and then be covered ? And does obamacare cover the recent Dr. and hospital bills for the recent catastrophic circumstance? Or are they out of luck ,so to speak?


Answer

You can't retroactively sign up for any health insurance type aside from Medicaid. This is why health insurance is important, even basic catastrophic coverage with a high deductible. This is also why the new cost sharing limits under the ACA are important. Over 60% of bankruptcies in the US are related to unpaid medical bills. Remember you can only enroll in health insurance during open enrollment.

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Albert Cohen on

Although the exact scenario of the question is not the same, it appears insurance companies are allowed to retroactively apply coverage. My wife and I enrolled in a plan on Jan 1st, 2016. Two months later (3/9), the insurance company terminated our policy. When asked, they said it was due to a missed payment but they then realized we were enrolled in auto-pay (and fully up-to-date) and they said it was due to the Marketplace (“something wrong” in our application). The Marketplace on the other hand still showed us as “active”, no sign of policy termination, no problem with the application. An escalation case was opened to reinstate coverage. Two months later (4/25), the coverage was successfully reinstated to 3/1. Having not gone to the doctor because of no coverage, this seems like a very good deal for the insurance company – 2 months of premiums without medical bills to pay. Just to make matters worse, today (5/2), the insurance coverage was dropped again. Reason given: something wrong with Marketplace application. On the Marketplace side, same story: shows us as active, nothing wrong, opening an escalation case. I expect that once all this is resolved, the insurance company will send a huge premium bill for all the months it decided “retroactively” to give us coverage for. I can’t quite see how health insurance can work retroactively: either you have medical costs or you didn’t, but once you know, what are your insuring against? Separately, in the event of a medical emergency, is the insurance company forced to cover it after all the paperwork problems they may be having with the Marketplace are resolved? Can they decide not to reinstate coverage at all?

Francis on

Not entirely true. You can enroll for Obamacare and get retroactive coverage if you had a life changing event, like moving, losing your job, and other things. As long as the event happened 60 days prior to you need insurance.