Now that everyone is able to have healthcare, it’s important to know when you are next able to enroll. While everyone can apply during the open enrollment period, some people may miss the deadline or simply don’t realize that there are other times of the year that you can apply. However, you have to qualify in order to qualify to enroll during one of these special enrollment periods.
Outside of the enrollment period, you can enroll in a private health place through the health insurance marketplace only if you qualify for a special enrollment period. While you can still apply for insurance at a private insurance company, you will not qualify for any subsidies that discount the price of the monthly premium.
Special enrollment periods designate a certain time frame that is customized for you to enroll in a health insurance marketplace plan. During this time frame, you can enroll in any plan and still receive government subsidies to make it more affordable even though you are technically outside of the open enrollment period.
Most people qualify for a special enrollment period if one of the following occurs:
- You go through a qualifying event like getting married, having a baby or lost other coverage.
- You experienced another complicated situation as described below.
- Some people do not need to apply during an open enrollment period or special enrollment period.
- Small businesses can apply for SHOP coverage at any time. Federally recognized tribes and Alaska Native shareholders are also eligible to apply through the Marketplace at any time of the year.
- You may also qualify for Medicaid or Children’s Health Insurance Program (CHIP) as well.
If you don’t know whether you will qualify for a special enrollment period, this guide gives you all of the basics on special enrollment periods including where and how you can apply.
What are Special Enrollment Periods?
Special enrollment periods are a time outside of the open enrollment period in which you or your family are able to sign up for health insurance. In the Marketplace, you may apply and qualify for a special enrollment period that starts 60 days following certain life events that involve a change in family status or a loss of health coverage.
In addition, a job-based plan also has a special enrollment period of 30 days.
Qualifying Life Events
A qualifying life event that can cause you to be eligible for a special enrollment period to sign up for health coverage is defined as a significant event that happens in your life that resulted in you either not have health insurance any longer or needing new insurance for a specific reason. Examples of a qualifying life event are:
- Recently giving birth or adopting a baby
- recently getting married or divorced
- recently losing your health coverage for some reason like you stopped working at your job and lost your employer-sponsored group health insurance policy
- You became a U.S. citizen or are otherwise considered a legal resident of the United States
- You are no longer incarcerated in prison or jail
- Your income has changed so that you are either now eligible or ineligible for a subsidy or healthcare through Medicaid or CHIP
- You moved to a new state and now need healthcare either through your state’s or the federal health insurance marketplace or through a private carrier that offers health insurance in your new geographic location
If you faced a natural disaster or serious medical condition that kept you from enrolling, you may qualify for a special enrollment period.
For example, if you were unexpectedly hospitalized, suffered from a cognitive disability or were a victim of domestic violence you may be eligible to enroll during a Special Enrollment Period on the federal health insurance marketplace or through a private carrier without fearing penalty for being uninsured. An earthquake, hurricane, massive flood or other natural disaster can also be a reason why you weren’t able to enroll and could be deeemed an exception circumstance.
Misinformation or Misrepresentation
If you applied but were the subject of misconduct by a non-marketplace enrollment assister such as a broker, counselor or insurance company agent, then you may qualify for a special enrollment period.
This would only apply if you did not get enrolled in plan or you were enrolled in a plan but it was the wrong one. You also may not have gotten a premium tax credit or cost assistance because you were not informed correctly.
The insurance company wasn’t able to process your enrollment because there was a technical error between the marketplace and an insurance company resulting in loss of insurance coverage or an inability to get coverage.
System Errors Related to Immigration Status
An error occurred in the processing of applications or system errors that caused you to get an incorrect eligibility response because of your immigration status.
Victims of Domestic Abuse
If you are the victim of domestic abuse and weren’t allowed to enroll at the time, and you receive advanced payments of premium tax credits separately from your spouse, you can apply during a special enrollment period.
What If I Don’t Qualify for A Special Enrollment Period?
If you are not eligible for a special enrollment period, then you should consider the private or short-term health insurance. In both cases you can’t receive a subsidy to reduce your monthly bill and you most likely will have to still pay the tax penalty at the end of the year since most plans aren’t ACA compliant. You can also check to see if you qualify for your state’s Medicaid program for the poor.