What is a Special Enrollment Period under Obamacare?
The Affordable Care Act (ACA), or “Obamacare” as it’s more familiarly known, has opened the doors for many Americans to obtain health insurance coverage. However, the yearly period when most anyone can enroll in a plan, called open enrollment, only runs for a limited time. What are the options for someone if they find they need coverage outside of this limited open enrollment period?
Open Enrollment Periods vs Special Enrollment Periods
Obamacare’s nationwide annual open enrollment periods typically run from November 1st through the following January 31st for each plan year. Open enrollment season is a once-per-year nationwide period when anyone can sign up for individual or family major medical coverage, change their existing health plan or cancel coverage.
Open enrollment may be the only time you can apply for an individual or family Obamacare plan on your own — unless you experience a qualifying life event that triggers a personal special enrollment period. Only those who qualify for a special enrollment period are eligible to apply outside of the yearly open enrollment.
Special Enrollment Periods and Qualifying Life Events
Qualifying life events can trigger a special enrollment period. These life changes can affect you personally, or they can affect someone in your household. When they happen, you may need to make a change to your health insurance coverage. If you experience a qualifying life event that affects your Obamacare insurance needs, you can take advantage of a special enrollment period. Obamacare identifies a number of specific qualifying life events, including the following:
- Marriage or divorce
- The birth or adoption of a child
- Moving to a new coverage area where your old plan no longer works
- Loss of employer-based coverage or COBRA
- Major changes in your income that may affect your eligibility for subsidies
Many of Obamacare’s special enrollment periods revolve around changes in the size of your household. Other qualifying life events are based on changes in your income, existing health insurance coverage, or changes in your place of residence. If you have an Obamacare plan and one of these events occurs, you’ll likely have 60 days from the time of the event to secure new Obamacare coverage or update your policy. Dropping or losing your old coverage without enrolling in a new plan could leave you open to potential tax penalties.
Obamacare Special Enrollment Periods Based on Changes in Family Size
Let’s look at several examples of qualifying life events under Obamacare that may trigger a special enrollment period. If you’ve experienced one of these qualifying life events in the past sixty days, you may be due a special enrollment period allowing you to apply for subsidies or enroll in a new Obamacare health insurance plan:
- You got married. Congratulations! You will have a 60 day special enrollment period from your legal wedding date to enroll in a new Obamacare health insurance plan or update your existing coverage for you and your new spouse.
- You had a baby or adopted a child. Congratulations again! In this case, your coverage can be back-dated to start the day of the child’s birth or adoption. You’ll have a 60-day special enrollment period to enroll in a new plan or update existing coverage from that date.
- You got divorced or legally separated and lost health insurance. We’re sorry to hear it. However, if you lost your health insurance as part of a divorce settlement or legal separation, you have a 60 day special enrollment period to enroll in an Obamacare plan. Getting divorced or legally separating from your former spouse without losing health insurance coverage does not trigger a special enrollment period.
- Death in the household. Our condolences. If someone in your household dies and you no longer are eligible for your Obamacare-compliant health insurance plan due to this death, you have a 60 day window to enroll in a new plan.
Special Enrollment Periods Released to Changes in Income, Coverage, or Place of Residence
Not all Obamacare special enrollment periods are related to changes in the size of your household. Other Obamacare special enrollment periods cover a variety of events that cause major disruptions to everyday life as well, such as:
- You moved to a new city. If you move to a city that’s outside the coverage area of your old health insurance plan, this is a qualifying life event. You have a 60-day special enrollment period from the date of your move to enroll in a new plan.
- You lost your employer-based coverage or COBRA. Losing coverage under an employer plan or running out the clock on your COBRA coverage (18 months in most cases) is also a qualifying life event. Your employer may no longer offer health coverage to employees or perhaps you left a job, or your spouse recently left a job, and you no longer have coverage. This also qualifies for a 60-day special enrollment period to find new coverage.
- Your income changes. If your income changes such that you are now eligible for subsidy assistance you may qualify for an Obamacare special enrollment period. You will have a 60-day window to find new coverage.
Obamacare Special Enrollment Periods and Health Insurance Subsidies
Remember, changes in the size of your household or your income may affect your eligibility for Obamacare subsidies (also known as premium tax credits). Moving to a new state may in some cases change your eligibility for subsidies too, since Alaska and Hawaii operate under different federally-defined poverty level guidelines.
If your income falls below 400% of the federal poverty level based on your household size, you may be eligible to apply for government subsidies that can effectively reduce your monthly health insurance premiums. Your special enrollment period is your opportunity to apply for subsidies. Once your special enrollment period is over, you will no longer be able to apply for subsidies until the next open enrollment period or until you experience another qualifying life event.
Obamacare Special Enrollment Periods and Other Qualifying Events
The qualifying life events described above are not the only ones that may trigger a special enrollment period, just some of the most common ones. There are other, more complicated life events that may qualify you for a special enrollment period under Obamacare.
Obamacare Special Enrollment Periods and You
Please note that when you claim a special enrollment period under Obamacare you must attest on your health insurance or subsidy application that the information you provide is true, including the fact that qualify you for a special enrollment period. You may be asked to provide documents that prove your eligibility to enroll with a special enrollment period. These could include a birth certificate for your newborn or proof of a new address if you move, among other things. This is done to ensure that there is indeed a qualifying event enabling you to enroll in an Obamacare plan outside of open enrollment.
In closing, remember that whenever life throws you a curveball (good or bad) and impacts your need for health coverage, open enrollment may not be your only opportunity to obtain Obamacare coverage. Special enrollment periods provide additional security and options for health insurance coverage when you need them most.