The Affordable Care Act, commonly referred to as Obamacare, seeks to expand access to health insurance for more Americans and foster medical care delivery that reduces costs.
The law also shields consumers from insurance companies that might increase patient costs or limit coverage.
If you need to enroll in an Affordable Care Act-compliant health plan, special enrollment periods are available. These are triggered by qualifying life events like losing other coverage, getting married, having a baby or having estimated household income exceed the threshold.
Open Enrollment Period
Open enrollment is the time when you can modify or enroll in a health insurance plan. On the Health Insurance Marketplace, you can shop for plans and compare their price, benefits, and networks to find one that best meets your requirements and budget.
At open enrollment, you have the option to add supplemental coverage like dental and vision to your ACA-compliant plan. Supplemental insurance helps protect you financially in case of an accident or illness that leaves you with large medical bills.
In addition to Open Enrollment, there are special enrollment periods. These are initiated when certain life events such as losing your previous health insurance, getting married or having a child occur.
Some of the most common special enrollment events include losing employer-sponsored coverage, becoming ineligible for Medi-Cal or student health coverage, exhausting COBRA coverage or aging out of your parent’s health insurance. If these apply to you, Covered California offers a special enrollment period in which you can purchase private health insurance.
Special Enrollment Period
The special enrollment period (SEP) allows you to enroll or change your health insurance plan outside the traditional open enrollment period. This SEP may be available for a variety of life events, such as losing job-based coverage or getting married.
The Special Enrollment Period (SEP) starts on the date of a qualifying event and continues for 60 days; typically, new coverage can take effect on the first of the month following enrollment. However, if you lose coverage due to an unforeseen reason (loss of employer-sponsored coverage, COBRA expiration, Medicaid eligibility loss), then you may enroll during SEP and your new coverage will take effect on January 1st following receipt.
You may use a special enrollment period to switch from one plan to another within an exchange. This can be especially advantageous if you relocate to a different state or area with different plans available in the marketplace.
Qualifying Life Events
As life unfolds, there are certain major milestones that may arise. These changes could make you eligible to shop for a health insurance plan outside the yearly Open Enrollment Period.
After turning 26, you may qualify for a Special Enrollment Period that provides you with the opportunity to secure health coverage as soon as possible. This is an excellent chance to get the coverage that you need and want.
To qualify for insurance coverage, you’ll need to show documentation for a qualifying event such as a birth certificate or adoption record. These documents should demonstrate how this event affects your coverage.
Some changes that can impact your insurance policy include getting married, adopting a child or placing foster children in your home. These events may require you to adjust your current plan or even switch coverage altogether.
How to Apply
Each fall, the annual open enrollment period for Obamacare health insurance plans opens up. Additionally, there are special enrollment periods under the ACA which permit enrollment outside of open enrollment when certain qualifying life events take place such as losing employer-sponsored coverage or having certain qualified health issues.
You may qualify for a subsidy to help cover the cost of your health insurance premiums. To find out if you qualify, use the savings estimator on this page.
If you have a pre-existing condition, it’s essential to shop around for health insurance that meets your requirements. The Affordable Care Act prohibits insurers from denying coverage or charging more based on your medical history.
The Affordable Care Act (ACA) offers various health insurance plans to suit different needs and budgets. These range from bronze, silver, gold, and platinum levels with varying deductibles and out-of-pocket expenses.
