Updates: In addition to the below content, I’ve also created a detailed list of health insurance options for the newly unemployed or uninsured for your review as well as an ACA open enrollment overview. One of the biggest selling points of the Affordable Care Act was that it would allow millions who previously had not had insurance to get affordable insurance through a public health insurance exchange. The biggest benefactors primarily included:
- Those without an employer plan who had pre-existing conditions
- Those who could not afford a plan on their own due to income, age, or some combination of the two
And between Medicaid expansion and the health insurance exchange (paired with subsidies), the ACA has greatly reduced the uninsured rate.
But now that open enrollment has closed, what if life (shit) unpredictably happens, as it often does, and you have a massive life changing event and need insurance coverage?
There’s always good ole COBRA, if you leave your job and want to extend your employer’s insurance plan. But it’s typically way overpriced. You can check out your W2, box 12, code DD to find out how much your employer and you (through premiums) are paying for your insurance plan. With COBRA, you’d pay that (broken down in to monthly premiums), plus up to an additional 2% admin fee. COBRA can last up to 18 months, if you are eligible.
As I discovered, your employer’s insurance plan can be way overpriced, which could make COBRA cost prohibitive for you. Then what?
The ACA marketplace open enrollment now only runs from the beginning of November to mid December for most states. That means everyone who wants to sign up for insurance has three months to do it, and nine other months where they cannot. Thankfully, there are exceptions.
For starters, if you are eligible, you can apply and enroll in Medicaid (through healthcare.gov) or the Children’s Health Insurance Program (CHIP) any time. There is no limited open enrollment period for these programs. Also, members of federally recognized tribes and Alaska native shareholders are eligible to enroll any time.
If you don’t fall in to one of those categories, then what?
You can still apply and enroll for a plan outside of open enrollment through a special enrollment, at any time. But in order to do so, you need to have a qualifying life event (QLE) to be eligible. Example qualifying life events include:
Changes in household Qualifying Life Events:
- Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
- Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
- Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
- Died. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.
Changes in Residence Qualifying Life Events:
Household moves that qualify you for a Special Enrollment Period:
- Moving to a new home in a new ZIP code or county
- Moving to the U.S. from a foreign country or United States territory
- If you’re a student, moving to or from the place you attend school
- If you’re a seasonal worker, moving to or from the place you both live and work
- Moving to or from a shelter or other transitional housing
Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.
Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.
Loss of health insurance Qualifying Events:
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days. (there are exceptions if you were impacted by COVID, however)
- Losing job-based coverage
- Losing individual health coverage for a plan or policy you bought yourself
- Losing eligibility for Medicaid or CHIP
- Losing eligibility for Medicare
- Losing coverage through a family member
Other Qualifying Life Events:
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
- Leaving incarceration
- Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member
There could be other circumstances that would make you eligible, not on this list. When in doubt, get in touch with an official marketplace navigator expert to ask questions.
Outside of life qualifying events, you’re on your own. You can still find a “short-term” health insurance plan on a private exchange or directly with insurance providers – but you won’t be eligible for a subsidy.
Good stuff to know for when life happens. And it will eventually.
Qualifying Life Event Discussion:
- Do you expect a qualifying life event this year that might lead to you signing up for a plan through the health insurance marketplace?