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Open enrollment for health insurance coverage in 2015 through the Affordable Care Act recently ended. The next time consumers can apply for coverage through an open enrollment period will be in November, for coverage that will be effective on Jan. 1, 2016.
There are, however, special circumstances, or “qualifying life events,” that will allow some consumers to enroll in health insurance coverage outside of the open enrollment periods.
In most cases, you can start shopping for a new ACA plan 60 days before the date of a qualifying life event, such as getting married, having a child or turning 26. Your special enrollment period starts on the date of the event and ends 60 days later.
The federal premium tax credits and cost-share subsidies that are available during open enrollment periods will also be available for qualified consumers during these special enrollment periods. But if you don’t enroll within those 60 days, you’ll need to wait until the next open enrollment period in November.
Let’s take a closer look at some of the common qualifying life events under the ACA, and what consumers need to do to make sure they are enrolled in coverage.
Common qualifying events
One of the earliest provisions enacted under the ACA allowed dependents to remain on their parent’s health insurance plan up to the age of 26. But when you turn 26, depending on the terms of your policy, you might “age off” your parent’s plan and be required to find your own coverage. If your 26th birthday will occur before the next open enrollment period in November, be sure to check with your parent’s insurer about the terms of their plan.
If you don’t have the option of health insurance through your own employer, you might need to buy your own insurance during a special enrollment period to avoid a gap in coverage. Since this will likely be the first time you’ll have your own insurance, it’s a good idea before your birthday to visit the Federally Facilitated Marketplace – also referred to as “the public marketplace” – at healthcare.gov.
After setting up an account, you can find important information before you actually purchase coverage – information about the coverage options that are available, what the cost will be and whether or not you qualify for tax credits or subsidies to help cover your costs.
Another common qualifying life event is marriage. If you’re getting married before the next open enrollment period in November, and your future spouse doesn’t have health insurance coverage, you can add him or her to the coverage you purchased through the Federally Facilitated Marketplace up to 60 days after your wedding date. The time before and after a wedding can be hectic, so again, it’s a good idea to start shopping at healthcare.gov as soon as possible to see what coverage options are available and what you and your future spouse can fit into your budget.
Similarly, you can add a new baby, an adopted child or a foster child as a dependent to your coverage up to 60 days from the date the child joined your family.
Not all qualifying life events may be happy occasions. For example, if you lose your job or have a death in the family and your health insurance coverage is affected, you can enroll in new coverage on the public marketplace within 60 days.
Some of the events mentioned above might necessitate a move to a new state, or to a new location where different insurers are offering coverage. In Pennsylvania, for example, the insurers offering coverage in the western part of the state differ from those offering coverage in the eastern part of the state.
Making this type of move is considered a qualifying life event under the ACA, and you can enroll in new coverage on the Federally Facilitated Marketplace – or on a state exchange if the state you are moving to offers one – up to 60 days following the date of your move.
Additional special enrollment periods
If you are enrolled in a plan that started before Jan. 1, 2015 and you lose qualifying coverage sometime this year, you will have a special enrollment period to sign up for new coverage. This special enrollment period generally runs from 60 days before your plan ends to 60 days after your plan ends.
To make sure that you don’t have a gap in coverage, you must enroll in a new plan by the 15th day of the last month of your current plan’s coverage. For example, if your current coverage ends on June 30, you must enroll by June 15 when enrolling on the marketplace for your new coverage to begin on July 1.
It’s important to remember that if you don’t enroll in coverage during the special enrollment period for a qualifying life event like the ones mentioned above, you won’t be covered for the rest of the year. The ACA requires that most people have health insurance, and if you’re not covered, you might have to pay a tax penalty.
Some individual consumers did have to pay a tax penalty for not having coverage last year. A special enrollment period that runs through April 30, however, has been established for these consumers to sign up for coverage this year. To find out if you are eligible for this special enrollment period, visit healthcare.gov/get-coverage.
There are so many good reasons to have health insurance – such as having peace of mind if you get sick or have an accident, accessing the preventive services and screenings that are covered, and possibly getting help paying for your coverage and out-of-pocket expenses – that consumers who are eligible for special enrollments periods should take advantage of the opportunity to get covered.
For more information about qualifying life events, special enrollment periods, tax credits and subsidies, consumers can visit Blue Cross of Northeastern Pennsylvania’s website at store.bcnepa.com/learn.