When signing up for insurance you’ll find that most providers offer open enrollment periods, generally at a set time each year, that last for just a couple of months. During this time, participants are allowed to sign up for coverage, make elections concerning coverage, and generally lock in the particulars of their policy, which then go into effect until the next open enrollment period. The Affordable Care Act (ACA), also called Obamacare, is no exception to this rule. When you decide to apply for insurance through the healthcare marketplace (via your state exchange), you will have to comply with open enrollment periods, which generally run from about the beginning of November through the end of January the following year.
However, you might be concerned about what will happen should you experience major life changes that tie in to your health care. What if you lose your job and your employer-sponsored health coverage and need to obtain a new policy to remain in compliance with ACA mandatory minimum essential coverage rules? What if your child turns 26 and is no longer able to receive coverage under your plan, or you have another child that requires coverage? If these events don’t occur during the open enrollment period, how can you make necessary changes to your health insurance coverage?
Insurance providers understand that major life events don’t always occur around their open enrollment periods, and they have compensated for this by making exceptions for qualifying events. If events happen to fall during the open enrollment period, you need not worry – this is the time when anyone can enroll in a health insurance plan or make changes to an existing plan. However, if specific qualifying events happen to fall outside the open enrollment window, you do have recourse. You may be eligible to take advantage of a special enrollment period.
Obamacare, in particular, offers a wide variety of qualifying events. Outside of the ACA marketplace, private insurance providers offer many of the same options, but not all. Generally speaking, qualifying events could include involuntary job loss (firing, layoff, etc.), reduction of employer-sponsored health benefits (such that they no longer meet mandatory minimum standards), marriage or divorce, gaining or becoming a dependent, gaining U.S. citizenship, or making a permanent move to an area with different qualified health plans. You can also enjoy a special enrollment period if an error occurred during open enrollment that was the fault of the exchange, the Department of Health and Human Services (HHS), or anyone assisting you in enrollment.
Under Obamacare, gaining citizenship or lawful resident status is considered a qualifying event, but outside the ACA system, this may not be the case. The same goes for having Native American status, which under the ACA allows for extensive enrollment periods (providing for changes to policies as often as once per month). However, private insurance providers need not offer these considerations, and do so only at their discretion. If you’re not sure if an event requiring changes to your health insurance meets the standards for a qualifying event, simply contact your insurance provider or a representative of the healthcare marketplace for assistance in making a determination.
Submit your questions below or start a conversation in the comments!