Did You Miss Open Enrollment?


It can be confusing to know when you are able to sign up for the Affordable Care Act marketplace insurance plans. There is an open enrollment period from November 15th to January 15th of each year, according to Healthcare.gov. During this time you can join a healthcare plan, switch a plan, or drop an insurance plan. However, there are ways that you can sign up for a program if you missed open enrollment under specific circumstances and a health insurance broker can help you with this. Read on to learn more.

Private Insurance Plans – Can Be Available Year Round!

In most states, you can get privately insured individual plans at any time during the year. These types of plans are often available through membership in a specific type of Association. These plans are underwritten, where you must disclose your medical history, and may exclude pre-existing conditions. These can be great options if you are generally healthy, and find the ACA Marketplace plans unaffordable for your “household” and your “income” level. Private plans do not include ACA Minimum Essential coverages.

Special Enrollment Period (SEP)

Special Enrollment Period, or SEP, is the ability to buy ACA marketplace insurance within 60 days following what is called a ‘qualifying event’. This can happen at any time after the open enrollment period ends and prior to a new open enrollment period. Obviously, during the open enrollment period, you do not need a qualifying event. If you have questions about SEP and if you qualify with your circumstances, you must contact a health insurance broker quickly before your time runs out.

Qualifying Life Events

Qualifying special enrollment period events include a loss of health coverage, such as losing coverage after turning 26 from a parental or guardian plan, losing your Medicare or Medicaid eligibility, or losing your existing health care plan. If you have a change in residence from moving to a different zip code, are a student moving to or from where you went to school, or are a seasonal worker moving to or from a place of work, you may qualify. There are qualifying reasons for household changes such as having a family death, having a baby, adopting a baby, getting married, or getting divorced.

Additional changes that can allow you to apply for the special enrollment period include becoming a U.S. citizen, any change that makes you ineligible for CHIP or Medicaid, gaining status as an ANCSA corporation shareholder, gaining a federally recognized tribe membership, getting out of prison, or by beginning or finishing an AmeriCorps State and National, NCCC or VISTA member service.

Non-Qualifying Life Events

There are events that do not qualify as a special enrollment period ‘qualifying event’. These are changes in how much you pay for childcare, getting a promotion or a demotion at work, moving in with a significant other, any unpaid leave of absence outside the parameters of the Family Medical Leave Act (FMLA), having your health insurance canceled for nonpayment, or having a loss of health insurance coverage from canceling your policy.

SEP Exceptional Qualifying Circumstances

There are a few events that trigger the “unusual and complex” circumstances that will qualify them for the special enrollment period of the Affordable Care Act marketplace insurance. Some examples of these types of events include natural disasters, sudden hospitalization, temporary cognitive disability, spousal abandonment, domestic abuse, or technical errors during open enrollment. Talking with a health insurance broker can let you know if your situation qualifies for the SEP.

Speaking to a Health Insurance Broker

As you can see there are some qualifying events that are very simple to understand and some that are quite complex. Speaking to a Marketplace Certified health insurance broker is one way to cut through all the confusion and have your situation analyzed to see if you qualify to get ACA marketplace insurance outside of the open enrollment period. By doing so, you are saving time and money to not have to sit by and wait for a new enrollment period. This can help keep you and your family safer and have the medical coverage you need.

If you have concerns about signing up for ACA or private health insurance, please contact us at Health Insurance Advisors to talk about your options. There may be extenuating circumstances that help you get coverage outside of the open enrollment period and talking with a health insurance broker can help you understand how to go about that process. We’re here for you and your health insurance needs anytime, just give our office a call. We are here to listen and provide our years of expertise in the healthcare insurance field to help you get your medical insurance. Put our education and experience to work for you and your family.

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