The Affordable Care Act (ACA) is an expansive piece of legislation which encompasses numerous aspects of health insurance coverage, such as consumer protections, regulations, subsidies, taxes and exchanges.
The Affordable Care Act also mandates an Employer Mandate, which mandates large employers to offer coverage or face a fee; as well as an Individual Mandate which mandates individuals purchase health insurance or face penalties.
What is Open Enrollment?
Open enrollment is the period during the year when most types of health insurance allow individuals to sign up or change plans, often called an open enrollment period. People have an opportunity to review options, make modifications and sign up for coverage that starts on January 1 (for employer-based plans). While other forms such as short-term or medicare alternative policies can be purchased anytime throughout the year; open enrollment in Obamacare generally occurs between November and January in most states.
The Affordable Care Act also offers special enrollment periods to accommodate life changes that warrant enrolling outside of open enrollment window. Make sure your plan information remains up-to-date as income or circumstances alter to avoid unexpected costs you cannot cover and consider setting up automatic payment of premiums as it can make life much simpler and reduce stress!
What is a Special Enrollment Period?
Obamacare makes health insurance more accessible, offering many consumer protections such as coverage for preexisting conditions and reduced out-of-pocket costs.
The Affordable Care Act also established an annual open enrollment period, making it easier for people to purchase health coverage that complies with law’s requirements. Short-term health insurance and Medicaid are available year round and do not need to wait for open enrollment period to sign up.
Certain qualifying life events enable you to enroll outside of the open enrollment period, including having a baby, marrying someone new or losing your job. When enrolling during a special enrollment period your coverage can start as early as the month following your qualifying event and prevent gaps in coverage – the special enrollment period lasts 60 days for this purpose – click here for more details.
What is a Qualifying Event?
An “Outside Open Enrollment Period Qualifying Life Event” refers to any significant change in your situation that allows you to enroll or make adjustments in your health insurance plan outside the yearly Open Enrollment Period, such as losing or changing jobs, getting married, having a baby or moving. Examples may include losing or changing jobs, getting married, having a baby, moving or changing residence.
Certain life events may qualify you for a special enrollment period, giving you 60 days to secure health coverage – either on an exchange or off. This gives you an opportunity to select an ACA-compliant health policy without going through an exchange.
Other changes could make you eligible to enroll in a new health insurance policy, including getting married, having a baby or moving. For maximum effectiveness it’s wise to consult an expert and speak to your employer to assess whether any events qualify as qualifying events so as to avoid gaps in coverage.
How do I know if I qualify for a Special Enrollment Period?
Dependent upon the nature of your qualifying life event, you may have up to 60 days from when it occurred in which to apply or change marketplace plans both on and off-exchange; this window applies for both enrollments. Please be aware that insurers have strict rules regarding proof of SEP eligibility.
New parents qualify for an SEP if they have never been enrolled before, though due to market stabilization rules issued in April 2017 they are restricted in their eligibility: if already enrolled in a Qualified Health Plan (QHP), their new baby and they must enroll into another plan with the same metal level.
2022 also saw the introduction of a special Savings Enhancement Plan (SEP), offering nearly free benchmark plans throughout the year for consumers experiencing major life events with annual income below 150% of poverty levels. Through this SEP they may access near free benchmark plans throughout their time in poverty.