Non-Marketplace Health Insurance Premiums
In some limited situations, insurance companies sell private health plans outside the Open Enrollment Period that count as qualifying health coverage.
- These plans meet all the necessities of the health care law, cover pre-existing conditions, offer free preventive care, and not capping annual benefits. If you have one of these plans, you will not have to pay the fee that people without coverage must pay through the 2018 plan year. (Note: Beginning with the 2019 plan year (for which you will file taxes in April 2020), the charges no longer apply.)
- The Marketplace does not list or provide these health insurance plans. The only way you can enroll in health insurance coverage through the Marketplace outside Open Enrollment is if you qualify for a Special Enrollment Period.
- You can find these coverages through some insurance companies, agents, brokers, and online health insurance sellers. If you purchase a health insurance plan outside the Marketplace any time, during Open Enrollment or not, you cannot get premium tax credits or other savings based on your income.
- Insurance companies can tell you if a specific plan counts as minimum essential coverage. Every plan’s Summary of Benefits and Coverage also comprises this information.
Note: Most health plans sold outside Open Enrollment do not count as qualifying health coverage.
Qualifying Health Coverage
Qualifying health coverage is any health insurance plan that attains the Affordable Care Act requirement for coverage. If you have qualifying health coverage (or “minimum essential coverage” or “MEC”), you do not have to pay the penalty for being uninsured through the 2018 plan year.
Examples: individual plans, Marketplace plans; job-based plans; Medicare; and Medicaid & CHIP.
A complete list of qualifying health coverage:
- Job-based health insurance coverage
- Health insurance sold through the Small Business Health Insurance Program (SHOP) Marketplace
- Health Insurance Marketplace coverage
- Most individual plans purchased outside the Marketplace
- The Children’s Health Insurance Program (CHIP)
Getting Health Coverage Outside Open Enrollment
Because the 2020 Open Enrollment Period is ended, you can now enroll in or change your Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.
Life Changes that Can Qualify you for a Special Enrollment Period
Changes in Household
You may be eligible for a Special Enrollment Period if you or anyone in your family in the past 60 days:
- Got married. Choose a plan by the last day of the month, and your coverage can begin the first day of the next month.
- Had a baby, adopted a kid, or placed a child for foster care. Your coverage can begin the day of the event — even if you enroll in the plan up to 60 days afterward.
- Got divorced or legitimately separated and lost health insurance. Note: Divorce or legal separation without losing coverage does not qualify you for a Special Enrollment Period.
- Died. You’ll be qualified for a Special Enrollment Period if someone on your Marketplace plan dies, and as a result, you’re no longer qualified for your current health plan.
Changes in Residence
Household moves that make you eligible for a Special Enrollment Period:
- Relocating to a new home in a new ZIP code or county
- Moving to the United States from a foreign states or the United States territory
- If you are a learner, moving to or from the place, you attend school
- If you are a seasonal worker, moving to or from the place, you both live and work
- Moving to or from a shelter or other temporary housing
Note: Moving only for medical treatment or staying somewhere for vacation does not make you eligible for a Special Enrollment Period.
Important: You must confirm you had qualifying health coverage for one or more days during the 60 days prior to your relocation. You don’t require to confirm if you’re moving from a foreign country or U.S. territory.
Resources and References: