Before the Affordable Care Act (ACA), or Obamacare, was implemented, consumers without health insurance could only access half as much healthcare than those covered. That changed in 2009 with its passage into law.
Open enrollment periods allow you to enroll, re-enroll, or switch plans, while special enrollment periods provide coverage after qualifying events such as losing existing coverage or getting married.
Open Enrollment Period
Typically, the best time and place to purchase Affordable Care Act-compliant health insurance policies is during open enrollment periods. This applies whether individual/family coverage is purchased through the marketplace or directly from insurers (off exchange).
The open enrollment period for 2019 – 2023 starts November 1 and concludes January 15, though you may qualify for an extended enrollment period due to significant life changes like losing coverage or getting married.
Medicaid and Children’s Health Insurance Program can also be enrolled at any time throughout the year if you meet income and other criteria, which is especially helpful as an individual mandate penalty requires having health insurance or paying a tax penalty (although not applicable on the federal level anymore); some states still enforce it to discourage adverse selection – the practice where healthy people purchase health coverage when needed only.
Special Enrollment Period
Special Enrollment Periods (SEPs) provide individuals the chance to enroll or make changes to their health insurance coverage outside of the standard Open Enrollment Period. These special enrollment periods typically last 60 days and can be triggered by certain life events.
Qualifying life events include things such as losing or gaining employment, moving to a different state, getting married, having children grow older or the addition of a new baby into your family composition. HHS does not mandate SEPs on off-exchange plans due to this difference – for instance carriers do not need to offer such SEPs when someone gains citizenship or lawful presence in the US.
Exchange enrollees who purchased silver plans with cost-sharing reductions on the exchange who experience changes that no longer qualify them for those subsidies can also access this SEP up until 2025.
Short-Term Plans
In many states, insurers provide short-term health plans. These policies typically last less than one year and don’t meet the Affordable Care Act requirements; they typically feature lower premiums than plans that comply with the law but may lack consumer protections required by it.
Federal regulations had restricted short-term health insurance policies to three month limits until recently, however under President Donald Trump those rules have been relaxed; insurers will soon be able to offer short-term policies with initial coverage periods of up to 364 days!
Short-term health insurance plans may fill coverage gaps, but should not be seen as an alternative to major medical health plans that comply with the Affordable Care Act (ACA). Furthermore, these short-term plans do not guarantee issue, so you’ll have to go through underwriting and answer a series of medical questions in order to obtain coverage; additionally these short-term plans do not cover preexisting conditions which are covered under an ACA plan.
Medicaid
Medicaid is a joint state and federal initiative designed to ensure low-income individuals have access to medical care. It offers essential health benefits, including hospitalization and doctor visits, to certain groups such as children, parents, pregnant women, elderly individuals with disability as well as those who incur high medical expenses.
The federal government provides basic guidelines, while each state establishes its own eligibility standards and determines how much of the program’s costs will be shared between state and federal funding sources. Medicaid coverage is open to residents with income below 133% of poverty level as well as optional coverage for some individuals who exceed their Medicaid coverage limits, such as those who incur medical costs which exceed that limit.
New York State of Health uses a website to help individuals apply and enroll for Affordable Care Act insurance plans. Visitors can browse plans by county and filter by type of plan, insurance provider, monthly premiums or any other relevant features. Furthermore, assistance services are also offered free of charge to guide individuals through this process.
