Sometimes life happens, for better or worse. The Obamacare plan you chose no longer makes sense for you and your growing family. You lose access to your employer-sponsored health insurance. You move out of your current plan’s coverage area to pursue a new opportunity.
Fortunately, you may not be stuck in a situation where you’re uninsured or in a plan that doesn’t fit.
If you experience what the Affordable Care Act considers a qualifying life event, you may be eligible for a special enrollment period—a set amount of time in which you may enroll in an Obamacare health insurance plan or switch plans outside of annual open enrollment.
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What triggers a special enrollment period?
According to HealthCare.gov, the following qualifying life events can result in special enrollment eligibility3:
- Loss of health coverage – This includes losing your current job-based, individual and student plans; eligibility for Medicare, Medicaid or CHIP; and turning 26 and aging out of a parent’s plan.
- Changes in household – This includes getting married or divorced, having a baby or adopting a child, or experiencing a death in the family.
- Changes in residence – This includes moving to a new ZIP code or county, students moving to or from the place they attend school, seasonal workers moving to or from the place they both live and work, and moving to or from a shelter or other transitional housing.
- Other qualifying events – This includes income changes that affect the coverage for which you qualify, gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, becoming a U.S. citizen, leaving jail or prison, or AmeriCorps members starting or ending their service.
These are the most common ways to qualify for a special enrollment period; however, there may be other situations in which you could become eligible. To determine whether or not you qualify, you will want to work with a health insurance producer or contact your state’s ACA exchange.
Under new regulations effective in 2017, you will be required to provide documentation that confirms your eligibility.
How long does special enrollment last?
Your eligibility begins with the date of your qualifying life event. The length of your special enrollment period depends on what situation triggered it, but 60 days is common.4
To find out if you qualify for a special enrollment period and for what duration:
- Use Agent Finder to search for a local agent who can work with you in person.
- Visit HealthCare.gov and answer a few questions. This screening tool will help you determine whether or not you may be eligible and point you toward the correct state-based or federally facilitated exchange from which to begin the application process.
- Contact your state-based or federally facilitated exchange—IRS.gov lists all exchange websites and phone numbers here.
What if I don’t want to buy from an exchange?
Special enrollment is not confined to state-based and federally facilitated health insurance exchanges. If you qualify for special enrollment, you may also purchase qualified health insurance plans in the private marketplace.
Note, however, that premium tax credits and cost-sharing subsidies may only be applied to health insurance plans purchased through state-based and federally facilitated exchanges. To estimate your Obamacare tax credit, use the healthedeals.com Health Care Reform Calculator.
Not eligible for special enrollment?
You may consider health insurance options that are available for year-round enrollment, including Medicaid, short term health insurance or supplemental coverage such as a hospital indemnity plan. Applicants for these plan types are subject to certain eligibility criteria.
While Medicaid is considered minimum essential coverage under the Affordable Care Act, plans such as short term health insurance and hospital indemnity are not. However, short term health insurance does provide temporary benefits that can help you pay for unexpected medical expenses until your next Obamacare plan begins, and hospital indemnity coverage provides supplemental fixed benefits for covered hospitalization, surgery, chemotherapy and radiation services—you can keep a hospital indemnity plan even after your next Obamacare plan begins.
Call the number at the top of your screen to discuss short term, hospital indemnity and other coverage options with a certified advisor from HealtheDeals.com.
To learn more about Medicaid where you live, visit your state-based or federally facilitated health insurance exchange website or go to Medicaid’s State Overviews page and click on your state.