The much-publicized deadline to enroll in health insurance has come and gone as of January 31st. Consumers now enter a new world where they can no longer enroll in health insurance or jump between health insurance carriers freely. However, there are still ways to get health insurance in the new “offseason” created by the Affordable Care Act.
- Special Enrollment Periods for those with Qualifying Events
- Group Insurance
- Short-term health insurance
We talked about short term insurance earlier this week so today let’s focus on Special Enrollment and its surprisingly large list of triggers that may allow you to enroll in health insurance even after the Open Enrollment deadline.
What is a Special Enrollment Period?
“Stuff happens.” This is essentially the reason why we have Special Enrollment Periods. There are many situations beyond your control that would cause you to either need to change your policy or replace it entirely. These things are called Qualifying Events and they trigger a Special Enrollment- aka an exception that allows you to enroll in coverage outside of Open Enrollment. What are these Qualifying Events?
Losing Health Coverage
If you are losing your health insurance, you may be eligible for a special enrollment. This most frequently happens when you change jobs or lose eligibility for state plans like Medicaid/Medi-CAL. However, there’s one big exception- voluntary loss of your own coverage does NOT trigger a Special Enrollment. You can’t just fail to pay your bill and use that as a way to switch coverage mid-year.
Change in Income
If your income changes to the point that you are newly eligible or ineligible for assistance paying your monthly premiums, you may be eligible for a Special Enrollment
Ageing out of your Parents Plan
If you are on your parents’ medical plan and turn 26, you’ll lose coverage and open a Special Enrollment to sign up on your own
Change in Residency
If you move to a new place and gain access to new health plans you may be eligible for a Special Enrollment. This includes moving to California from another state or being released from prison as well.
Change in Household Makeup
Did you just get married? Have a child? adopt? Any changes in household makeup can potentially trigger a Special Enrollment Period. This also includes divorce or change in domestic partnership.
Change in Citizenship/Residency Status
Did you just gain your citizenship or become lawfully present? You may also be able to now sign up for health insurance via Special Enrollment
A few longshots worth mentioning:
Membership in Federally Recognized American Indian or Alaskan Native Tribe
If you belong to either of these two groups, you can change your coverage once a month regardless of open enrollment and its deadlines.
On a case-by-case basis, the exchange will consider extraordinary circumstances to open a Special Enrollment and allow you to enroll. These are exceedingly rare and can take a long time to approve.
These Qualifying Events are not perpetual. You have a limited amount of time to exercise them and establish your personal Special Enrollment period. Generally you have 60 days from the Qualifying Event to enroll in a new plan or change your existing plan. It’s also important to understand that even in Special Enrollments, the coverage will always start on the first of the month. This may leave you without coverage for a few days depending on when you lost your old coverage. In these circumstances, some clients have combined the Short Term coverage with the Special Enrollment to leave no gaps in coverage. The one exception here is when you have a Special Enrollment for childbirth. Coverage will begin on the actual day of birth, naturally.
If you think you’re eligible for one of these Special Enrollments feel free to contact us and we’ll give you all of your options or comment below- I read and respond to every one!