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How to Get Health Insurance Outside of Open Enrollment?

Open Enrollment is a set period of time during the year when you can buy Marketplace health insurance.

Health insurance is vital. When you have coverage, you can easily receive routine checkups, fill prescriptions, visit a professional, or take care of anything more serious. Nevertheless, if you are looking to enroll in health insurance outside of Open Enrollment, you do not want to have to wait. In this article, we are going to go over how Open Enrollment works, why it was created, and who is eligible for coverage outside of an Open Enrollment Period (OEP).

To make things easier, we created a free checklist that comprises all of the information you will want to have on hand when applying for health insurance. Grip it here and save your computer for future reference.

What is Open Enrollment?

One of the key changes under the Affordable Care Act (aka Obamacare) is the introduction of Open Enrollment. Open Enrollment is a set period of time during the year when you can purchase Marketplace health insurance or change your health insurance policy. Last year, the marketplace open-enrollment fell between November 1st – December 15th.

Why Open Enrollment Was Created?

Before the Affordable Care Act, health insurance companies could raise insurance premiums or refuse coverage to an individual due to their medical history. The Affordable Care Act made it illegal for insurance companies to deny coverage because of someone’s medical history or any type of pre-existing condition. It also made qualifying health insurance a requirement to have for just about all residents of the United States.

So now, when somebody pays their monthly insurance premium, it typically goes into a large pot (and everyone – sick or healthy – contributes). And this gives insurance carriers the ability to put that money towards medical care whenever a shopper needs it.

Special Health Insurance Enrollment Period

Now let us tackle the big question: “Can I enroll in health insurance outside of Open Enrollment?”

Qualifying events include a change in household size.

To enroll in health insurance outside of an Open Enrollment Period, you will require to experience a qualifying life event that prompts a Special Enrollment Period (SEP). In most instances, if you experience a qualifying life event, you can enroll up to 60 days after the event.

What Is a Qualifying Life Event?

A qualifying life event is a significant change in your life that would make you qualified for health insurance outside of an Open Enrollment Period. This kind of significant life event includes losing coverage, having a baby, getting married, or becoming a citizen. Below is a detailed list of the various types of qualifying life events:

• Lost Job-Based Coverage   This applies to you even if you voluntarily left your employment or decreased your work hours. It also applies if your job-based coverage doesn’t meet current standards for value and affordability.
• Lost Coverage through an Individual Plan   This category comprises losing your coverage due to circumstances such as moving or no longer being a student. You do not qualify under this category if you stopped paying premiums, gave up on paperwork, or voluntarily withdrew from your individual plan.
• Lost Coverage through a Family Member  You are eligible under this category if you had health insurance through a family member’s plan and lost it due to death, divorce, or no longer being a dependent. Or if your family member lost coverage, making you lose it as well.
• Changed your Income   An increase in income may signify that you no longer qualify for Medicaid or premium-free Medicare Part A. A decrease could mean that you now qualify for Medicaid, which permits year-round Enrollment.
• Changed your Household Size  Have you gotten married, added a child to your household, or had a kid move out? You can enroll in a new health insurance plan within 60 days of this event.
• Changed your citizenship status  If you just became a United States citizen or have recently been released from incarceration, you can start over with new health insurance.
• Encountered exceptional circumstances   The Marketplace recognizes that life events are sometimes hard to classify. If you experienced one of these kinds of events, you may be eligible to enroll during the special enrollment period.

Resources and References:

• The Affordable Care Act
• Types of Qualifying Life Events