What Is a Special Enrollment Period for the Affordable Care Act?

Did you know you can’t enroll in Obamacare anytime you want? There are certain times of the year that are open to new enrollments. Outside of those times, you’ll have to have special circumstances to enroll in an Obamacare plan.
The good news is, there are quite a few life events that can qualify you for a special enrollment period. In addition, some circumstances have been extended due to the COVID-19 pandemic. We’ll review many of the qualifying life events here.

When Can You Enroll in Obamacare?

The national Affordable Care Act (ACA) open enrollment runs from November 1 through January 15 in most states. During that time, you can change your current Obamacare plan or enroll for the first time. If you apply by December 15, your effective date will be January 1. If you enroll after December 15, your coverage will not go into effect until February 1.
California and Colorado are the only two states that have permanently extended their open enrollment period. Those two states have a three-month enrollment window.
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Obamacare Special Enrollment Eligibility Requirements

To enroll outside of open enrollment, you must have had a qualifying life event that makes you eligible for a special enrolment period. Depending on what your situation is, you’ll have either 60 days before or 60 days after the event to get health insurance in Texas. If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can enroll at any time.
Let’s look at some of the qualifying events in more detail.

Change within a Household

If you or anyone in your household experienced one of these events in the past 60 days, you may qualify for a special enrollment.
●    Marriage: You must choose a plan by the end of the month and your current coverage will begin on the first day of the following month.
●    Birth or adoption: Your coverage begins on the day of the event and you have up to 60 days following the event to enroll. This also includes placing a child in foster care.
●    Divorce or legal separation: You must have also lost health coverage for this to qualify.
●    Death: If someone on your insurance plan passes away and you are no longer eligible for that plan, you qualify for a special enrollment.

Change of Residence

Moving often qualifies you for a special enrollment. However, you must have had qualifying health coverage for at least one day during the last 60 days before your move. This does not apply if you’re moving from a foreign country or U.S. territory.
●    Move to a home in a new county or ZIP code.
●    Move to the U.S. from a foreign country or U.S. territory.
●    Students who move to or from where they attend school.
●    Seasonal workers who move to or from the place they work. (They must also live there during that time.)
●    Move to or from transitional housing or shelter.

Loss of Insurance

If you lost qualifying health insurance in the last 60 days or expect to lose coverage within the next 60 days, you may qualify for a special enrollment period. In addition, if you lost health insurance more than 60 days ago but since January 2020 and did not enroll because you were affected by COVID-19, you might still qualify.
●    Loss of employer-sponsored plan: You can qualify for a special enrollment if you lost coverage through your (or your family member’s) job. You do not qualify if you are a dependent who voluntarily dropped their coverage, unless you also had a change in income or your previous insurance that made you eligible for savings on an Obamacare plan.
●    Loss of self-purchased plan: If you lost your individual health insurance, by one of the following methods, you can qualify for a special enrollment.
○    Your plan was discontinued.
○    You’re no longer eligible for a student plan.
○    You no longer live in the plan’s service area.
○    Your plan is ending in the middle of the year and you choose not to renew it.
○    Your household income decreased, and you qualify for savings on an Obamacare plan.
●    Loss of Medicaid or CHIP: You can qualify for a special enrollment if you lose your eligibility for Medicaid or your child ages out of CHIP.
Loss of Medicare: You might qualify if you are no longer eligible for premium-free Part A. (This is usually in case where someone was on disability and is no longer disabled.)
●    Loss of plan through family: There are a few reasons you might lose coverage through a family member.
○    You turn 26 and are no longer eligible to remain on the plan.
○    The subscriber loses their health coverage.
○    You get divorced or legally separated and lose coverage.
○    You lose coverage due to the death of a person in your family.
○    You are no longer a dependent to a parent or guardian.

Other Life Events

There are still other events that might qualify you for a special enrollment period.
●    You leave incarceration
●    You became a U.S. citizen
●    You are admitted to a federally recognized tribe or an Alaska Native Calims Settlement Act Corporation shareholder
●    You begin or send service as a VISTA, NCCC member, or AmeriCorps service member.
Outside of the events listed here, there are other more complex situations that could qualify for you for a special enrolment period for Obamacare. In addition, if you are turned down from being able to enroll, but believe you qualify for a special enrollment, there is an appeal process. You’ll have 90 days from the eligibility determination to submit an appeal.
If you don’t have health insurance and the open enrollment is closed, give CoverMile a call. We can help you determine if you qualify for a special enrollment period. And if you don’t, there are other ways to get your health insurance in Texas.