Open enrollment for 2016 ended on January 31. In most cases, the plans available outside of open enrollment without a qualifying event are not ACA compliant; they are subject to underwriting health questions and a tax penalty.Nevada is an exception. You could buy an off-exchange health plan year-round enrollment, but the effective date won’t start for the first 90 days.
If you missed open enrollment, the only way you could buy insurance is by having an event that triggers a special open enrollment window. That window lasts for 60 days from the event date. Prior to 2014, this was never an issue – people could apply for coverage anytime they wanted. However, policies were not guaranteed issue, had riders and exclusions, and carriers could also decline an individual based on health history.
In Today’s environment, individual and family plans are quite comparable to group coverage from an employer. As a result, the individual & family market has an annual open enrollment window and allows for special open enrollment triggered by qualifying events.
What Counts as Special Enrollment Period (SEP)?
Involuntary loss of coverage that is qualified as minimum essential coverage. (Short-term policies don’t count). such as:
According to the marketplace
- Turning 26 and losing coverage through a parent’s plan
- Losing eligibility for Medicare, Medicaid, or CHIP
- Losing existing health coverage, including job-based, individual, and student plans
Please Note: Canceling your current plan or failing to pay the premiums does not qualify as an involuntary loss.
Change in household size. such as:
- Getting married or divorced.
- Having a baby or adopting.
- Death in the family.Changes in residence to an area where other health plans are offered.
Other qualifying events such as:
- Changes in your income that affect the coverage you qualify for.
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
- Becoming a U.S. citizen.
- Leaving incarceration. (jail or prison).
What if I Don’t Have a Qualified Event?
- You will have to wait for the next enrollment period.
- Buy a short term policy. Available 1-12 months in some states.
Short-term plans are best suited for healthy individuals since they don’t cover any pre-existing conditions, preventative care, maternity and other services. A short-term policy is a good choice if you are in between jobs or need it for a few months until open enrollment.