The open enrollment period for the Healthcare Marketplace ends this week for people who want health insurance coverage in January. But there is an expanded open enrollment option this year for people who miss that deadline, and there are more insurance options for Alaskans.
Susan Briles is the Patient Health Benefits Manager for SEARHC in Haines, and she says time is running out for those who want coverage in the new year.
“If (they) want a January 1 start date they need to get enrolled by the end of the day December 15,” said Briles.
But, for those people who aren’t able to get enrolled by the end of the day this Thursday, the marketplace is now offering a longer open-enrollment period.
“If they enroll before January 15 of 2023, they will get a plan starting February 1, of 2023,” said Briles.
She also says special enrollment periods are available for people who lose coverage during the year due to a change in employment, loss of Medicaid benefits, or other life changes.
Two insurance companies are offering plans for Alaska residents through the Healthcare Marketplace at healthcare.gov this year. Premera Blue Cross which has been available since the inception of the Affordable Care Act, and Moda Health. Moda had been active in Alaska, left, and has come back in a limited role.
Briles says Moda’s limited participation in Alaska could lead to complications if you need to be seen by a provider that’s out of network
The Dahl Memorial Clinic in Skagway is not a participating member of the Moda network, though clinic representatives say they have reached out to the insurance company in an attempt to become a participant.
Patients that use a Moda plan can still be covered at the Dahl Clinic using what’s known as a Gap Exception. That means a patient would need to contact Moda prior to a regularly scheduled visit to get clearance so that the visit would be covered as in-network. There is a significant cost difference between in-network coverage and out-of-network coverage. Patients would not need a Gap Exception for emergency visits.
According to the Moda website, their insurance is accepted at SEARHC in Haines, and at the Klukwan Health Clinic.
For help signing up for a plan through the healthcare marketplace in Haines or Klukwan, contact the SEARHC patient outreach team at 907-966-8684 or email outreach@searhc.org. In Skagway, contact the Dahl Memorial Clinic’s Joe Terragrossa at 907-983-2255.
Per Moda’s website, “their insurance is accepted at SEARHC in Haines, and at the Klukwan Health Clinic” … per their website, it is in-network at these sites. DMC accepts Moda insurance, and will bill it, they are just out of network. Also, for urgent care and emergencies, a gap exception would still be required on the front end, or an appeal would need to be sent after the claim processes (on the back end). DMC is an FQHC and can only bill as such – they do not meet requirements to be considered an urgent care or emergency room and cannot bill as such, while they can still provide urgent and emergent care. Just FYI.
This is a common misnomer in the summer with the transient population visiting the DMC – their insurance says “yep, we cover urgent care and emergencies out of network with no authorization” – what they really mean is they cover services (with no authorization) at a dedicated urgent care or emergency room. This often ends up leading to large balances for patients, or stacks of appeals that need to be sent.