Frequently Asked Questions

Medical Insurance: Affordable Care Act


Finding Health Insurance When Open Enrollment Is Closed

With few exceptions, you must buy health insurance during the “Open Enrollment Period” (between Nov 1 and Jan 31 annually) . Open enrollment is the annual period in which shoppers can enroll, switch plans, and get subsidies on health plans. When the “Open Enrollment Period” ends the Health Exchange Marketplace is closed. That means individuals seeking health insurance can NOT buy it unless they have a “Qualifying Life Event” which opens a “Special Enrollment Period” or they qualify for Medicaid or CHIP coverage. This restriction prevents someone from waiting until they get sick before deciding to buy health insurance.

GET FREE HELP: There is no charge or fee to talk with a local Marketplace certified insurance agent. AMERICAN INSURANCE has experienced agents to help you find out if you qualify to purchase health insurance because of a qualifying life event. Idaho and Washington residents may contact our ACA Exchange certified health agents Dave Root, Tim Gleason or Mike Everett at 208-746-9646 to make an appointment. Or, you can contact AMERICAN INSURANCE via email or set an appointment.

A Qualifying Life Event…
Is a change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. Examples of qualifying life events are moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby).

So, Qualifying Life Events that create a Special Enrollment Period include:

  • Losing other health coverage. From 60 days before to 60 days after losing your other coverage
  • Being Denied Medicaid or CHIP. Up to 60 days after the denial.
  • Getting Married. Up to 60 days after the event.
  • Having a baby, adopting a child, or placing a child for adoption. Up to 60 days after the event.
  • Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions (if already enrolled in coverage). Only triggers special enrollment if it’s not open enrollment. Up to 60 days after the event.
  • Moving, gaining citizenship, leaving incarceration. Only triggers special enrollment if it’s not open enrollment. Up to 60 days after the event.
  • Employer special enrollment. Employer special enrollment periods typically last 30 days. If moving from a Marketplace plan, make sure to avoid gaps in coverage or overlapping coverage.
  • Hardship Exemptions and Enrolling in the Marketplace. Most hardship exemptions and even the act of simply enrolling in the Health Insurance Marketplace trigger a 60 day special enrollment window. Even more incentive to sign up during open enrollment or apply for a hardship exemption, even if you don’t have time to enroll properly.

Special Enrollment Period…
Is a time outside of the Open Enrollment Period during which you and your family have a right to sign up for health coverage. In the Marketplace, you generally qualify for a Special Enrollment Period of 60 days following a Qualifying Life Event. If you don’t have a special enrollment period, you can’t buy health insurance until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 30 days.

Medicaid and CHIP: Enroll any time
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time—there is no limited enrollment period for these programs. Medicaid and CHIP provide health coverage to millions of families with limited incomes. You can find out if you qualify for Medicaid or CHIP by filling out a Marketplace application or going directly to your state Medicaid agency.

Some states have expanded their Medicaid programs (WA state has, ID has not). See if your state is expanding Medicaid. If your state isn’t expanding Medicaid you may still be eligible, especially if you have children, are pregnant, or have a disability. Every state’s eligibility rules are different. If it looks like you’re eligible for Medicaid or CHIP, the Marketplace will pass along your information to your state agency, where you’ll be able to enroll. Find contacts for your state’s Medicaid and CHIP programs.

Source: US Health & Human Services, www.HealthCare.Gov

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FAQ Disclaimer

The content of FAQ articles are general in nature and are not intended as a substitute for professional legal, financial, or insurance counsel for individuals. Insurance coverage forms vary by issuing company and by state. For specific advice contact us.

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