Health insurance is important. When you have coverage you can easily receive routine checkups, fill prescriptions, visit a specialist, or take care of anything more serious. However, if you’re looking to enroll in health insurance outside of Open Enrollment, you don’t want to have to wait. In this article, we’re going to go over how Open Enrollment works, why it was created, and who is qualified for coverage outside of an Open Enrollment Period.
What is Open Enrollment?
One of the major changes under the Affordable Care Act (aka Obamacare) is the introduction of Open Enrollment. Open Enrollment is a set period of time during the year when you can buy Marketplace health insurance or change your health insurance plan. For 2017, it falls between November 1st – December 15th.
Why does Open Enrollment exist?
Before the Affordable Care Act, insurance companies could raise insurance premiums or refuse coverage to an individual based on their medical history. The Affordable Care Act made it illegal for insurance companies to deny coverage due to someone’s medical history or any type of pre-existing condition. It also made qualifying health insurance a requirement to have for just about all Americans.
So now when someone pays their monthly insurance premium, it essentially goes into a large pot (and everyone – sick or healthy – contributes). And this gives insurance companies the ability to put that money towards medical care whenever a consumer needs it.
What is a Special Enrollment Period?
Now let’s tackle the big question: “Can I enroll in health insurance outside of Open Enrollment?”
To enroll in health insurance outside of an Open Enrollment Period, you’ll need to experience a qualifying life event which triggers a Special Enrollment Period (SEP). In most cases, if you experience a qualifying life event, you’re able to enroll up to 60 days after the event.
What is a qualifying life event:
A qualifying life event is a significant change in your life that would make you eligible to enroll outside of an Open Enrollment Period. This type of major life event includes losing coverage, having a baby, getting married, or becoming a citizen.
Below is a detailed list of the different types of qualifying life events:
- Lost job-based coverage: This applies to you even if you voluntarily left your job or decreased your work hours. It also applies if your job-based coverage does not meet current standards for value and affordability.
- Lost coverage through an individual plan: This category includes losing your coverage due to circumstances like moving or no longer being a student. You don’t qualify under this category if you stopped paying premiums, gave up on paperwork, or voluntarily withdrew from your individual plan.
- Lost coverage through a family member: You qualify under this category if you had health insurance through a family member’s policy and lost it due to death, divorce, or no longer being a dependent. Or if your family member lost coverage causing you to lose it as well.
- Changed your income: An increase in income may mean that you no longer qualify for Medicaid or premium-free Medicare Part A. A decrease could mean that you now qualify for Medicaid, which allows year-round enrollment.
- Changed your household size: Have you gotten married, added a child to your household, or had a child move out? You can enroll in a new insurance plan within 60 days of this event.
- Changed your citizenship status: If you just became a U.S. citizen or have recently been released from incarceration, you can start over with new insurance.
- Encountered exceptional circumstances: The Marketplace recognizes that life events are sometimes hard to categorize. If you experienced one of these types of events you may be eligible to enroll during SEP.
Quickly find out if you qualify to enroll during a Special Enrollment Period here.
What do you need before you enroll?
Before you enroll it’s a good idea to collect the following information. You also want to gather information for anyone else you’re enrolling within your household:
- Household size
- Social Security Number(s)
- Household income for 2017 (best estimate)
- Information on how you file your taxes
- Income and employer information
- Documentation for legal immigrant(s)
- Policy number on any current health plans
- Proof of major life event
To see each of these in more detail click here.
Over the last few years, the dates for Open Enrollment have changed. Make sure to put a reminder on your calendar for Open Enrollment 2018 (November 1st – December 15th, 2017). And if you need health insurance outside of Open Enrollment and have experienced a qualifying life event, you can enroll during a Special Enrollment Period.
Looking to enroll in health insurance outside of Open Enrollment? Our Consumer Advocate team is happy to help you apply. Call us at (855) 772-2663 to get started.