By Rachel L. Boisselle
Health insurance is one of those things that most folks don’t really think about until they need it. While health insurance is a necessity, it can be difficult or impossible to obtain outside of set enrollment periods. Knowing the firm deadlines can help you stay on top of your healthcare and avoid going without insurance.
The health insurance landscape has changed dramatically over the past ten years. Before the Affordable Care Act came into full effect in 2014, a person could enroll in insurance at any time of the year. Insurance companies managed risk of financial loss by increasing premium rates or completely denying applicants with certain pre-existing conditions like diabetes, cancer, and mental illness. The Affordable Care Act forbade companies from raising rates or denying applicants on any pre-existing conditions except for age.
While invaluable to Americans with pre-existing conditions this mandate also required companies to take on an egregious amount of risk, which could be destructive to companies and policyholders alike. To offset this heightened amount of risk, The Affordable Care Act created limits on when individuals can enroll in insurance. Anyone not on Medicare can enroll in insurance during the Open Enrollment Period, which runs from November 1st to December 15th every year. Anyone on or of Medicare age can enroll in coverage October 15th to December 7th every year. While these deadlines are firm, there are exceptions to them called Special Enrollment Periods (SEP’s).
Special Enrollment Periods are temporary windows of opportunity that allow an individual to enroll in health insurance outside of Open Enrollment.
Special Enrollment Periods are instated as a result of a Qualifying Life Event. A Qualifying Life Event is a specific, dateable situation that changes a person’s current health insurance. Qualifying Life Events are not arbitrary. Rather, there are set guidelines on what does and does not quantify as Qualifying Life Event. The most common events are losing your existing coverage (losing your insurance because you didn’t pay your premium does not count), moving to a new insurance service area (typically to a new county), getting married, getting divorced, and having a baby/gaining a new dependent.
When you have a Qualifying Life Event, you will have 60 days starting from the event to enroll in health insurance.
Some examples of a Qualifying Life Event:
- Sarah and her partner are both uninsured but decide to get married on June 10th. They will be able to enroll in health insurance within 60 days of their wedding, or August 9th. If they try to enroll in coverage on August 10th, their window of opportunity will have closed and they will have to wait until Open Enrollment begins on November 1st, and their insurance will not begin until January 1st of the following year.
- James has insurance through his company, but is planning on retiring on March 31st and will lose his coverage that same day. James will have 60 days from losing his coverage, or until May 30th to enroll in coverage. If he waits until May 31st, his window of opportunity will have closed and he will have to wait until Open Enrollment begins on November 1st, and his insurance will not begin until January 1st of the following year.
- Alex has coverage through the Health Insurance Marketplace, but is moving to a new county where their plan is no longer offered. Alex doesn’t have to continue using the Health Insurance Marketplace, but they have 60 days from their move date to enroll in a new plan. If they wait 61 days after their move date, they’ll have to wait until Open Enrollment begins on November 1st, and their insurance will not begin until January 1st of the following year.
It is noteworthy that individuals on Medicaid, a state and federal program that assists individuals with limited resources, do not have to have a Special Enrollment Period to enroll in coverage. Additionally, losing Medicaid coverage because you had an increase in financial resources creates a Special Enrollment Period for you to enroll in a normal insurance plan. You will, however, have to abide the standard enrollment rules after moving out of Medicaid eligibility.