If you don’t have health insurance or can’t access affordable coverage, the Affordable Care Act (ACA) may be able to help. This law was designed with one goal in mind: making healthcare accessible for everyone regardless of income level.
During the Open Enrollment Period (November 1 to January 31), you can apply for ACA health insurance. Additionally, certain life events qualify you for additional assistance outside of this window.
Open Enrollment Period
The Open Enrollment Period for the Affordable Care Act is an annual period when individuals can apply for health insurance coverage. It usually runs from November 1 to January 31, though you may enroll outside this window if you experience a qualifying life event such as losing coverage, becoming pregnant, or getting married.
During the Open Enrollment Period, you can purchase insurance through either the Exchange, your employer or another source. Furthermore, during this time you may take advantage of federal or state tax credits to help cover premium costs – provided you meet certain income and other criteria.
Since November 1st, over 16 million people have chosen plans on the Exchanges – up 13% from this time last year. Of that total, approximately 3.6 million selections came from individuals who had never purchased a plan before.
Special Enrollment Period
If you’re facing a qualifying event, you can enroll in ACA-compliant plans outside the annual open enrollment period. This is known as a special enrollment period (SEP).
Typically, a SEP lasts up to 60 days from the date of the qualifying event. However, certain circumstances may trigger an additional 60-day window before this.
For instance, if you turn 26 before the end of your birth month, you can enroll in a plan through your employer up to 60 days after that to avoid a coverage gap.
After having a baby, adopting a child or placing your foster care child in your care, you can enroll them in your own health insurance plan. Coverage will begin on the date of adoption/placement and can continue up until your child turns 26 if desired.
HHS began tightening enforcement of SEP eligibility in 2016, amid concerns that there had been too much lax enforcement. You may need to provide evidence of your qualifying event before enrolling in an eligible program.
Enrolling in a Marketplace Plan
The Marketplace is an online tool created by the Affordable Care Act (ACA) to make it simpler for people without access to affordable health insurance to find a plan that meets their requirements and budget.
On the Marketplace, you’ll find plans that cover doctor visits, preventive services, hospitalization, prescriptions and more. These can range from Bronze to Platinum levels of protection for you and your family members.
If you need assistance applying for coverage, certified application counselors in your area are available to help. These individuals work at community health centers, hospitals or non-federal social service agencies and have received training on helping you enroll in a plan.
Under the Affordable Care Act (ACA), all health plans sold through the Marketplace must meet essential health benefits (EHBs). This includes preventive services, prescription drugs and coverage for pre-existing conditions.
Enrolling in a Medicaid or Medicare Plan
If you are a person with limited income and resources, you may qualify for Medicaid. This program is a joint state-federal initiative that provides health coverage to millions of Americans each year.
Medicaid serves a variety of populations, the primary being children, pregnant women and elderly individuals (Figure 1). It also extends coverage to individuals who do not qualify for Medicare or SSI benefits.
States also receive federal funds to cover “optional” populations such as seniors who do not receive SSI and have income below the eligibility limits; medically needy individuals with high medical expenses like nursing home care that reduce their disposable income below the eligibility limit; and people with higher income who require long-term services and supports (like in-home childcare for children).
Medicaid enrollees tend to experience better access and satisfaction with their health care than uninsured people, and are less likely to put off or forgo necessary treatments due to cost concerns. Furthermore, states are increasingly expanding managed care arrangements in an effort to help individuals with more complex needs gain access to vital healthcare services.
