Obamacare Special Enrollment Period - Qualifying Life Events

Affordable Care Act (Obamacare) Special Enrollment Period

What is the Special Enrollment Period?

The period in which a person can enroll in health insurance compliant with the Affordable Care Act (also known as Obamacare) is the open enrollment period. Enrollment outside of the open enrollment period requires Special Enrollment Period eligibility.

In order to enroll in a health plan during a special enrollment period, you must have a qualifying life event. Without a qualifying life event, you must wait until the next open enrollment period to buy a new health insurance plan.

What Constitutes a Qualifying Life Event?

Examples of Qualifying Life Events include the following:

  • Marriage
  • Relocation to a new area that is outside the healthcare provider network of your current health insurance plan
  • Birth or adoption of a child/dependent
  • Losing existing health insurance coverage due to:

Please note the list above is not exhaustive so you should contact a health insurance provider to see if you believe you have gone through a qualifying life event.

2015 Special Enrollment Period

HHS announced a special enrollment period for people who are in states that use the Federal health insurance marketplace (Healthcare.gov) AND face a tax penalty for being uninsured during 2014.

To be eligible for this special enrollment period, people must live in a state using the Federally-facilitated Marketplace (Healthcare.gov) and must be:

  • Currently unenrolled in health coverage for 2015
  • Willing to attest that when they filed their 2014 tax return they paid the fee for not having health coverage
  • Willing to attest that they first became aware of the uninsured penalty in connection with preparing their 2014 taxes

Several states that run their own health insurance exchanges are also granting special enrollment periods. Washington, Minnesota, Vermont, California, and New York have implemented special enrollment periods similar to the one offered to states using Healthcare.gov. In total, 47 states have a special enrollment period for those facing the uninsured penalty on their 2014 taxes.

What happens if I miss the Special Enrollment Period?

Special enrollment periods typically last 60 days from the date of the qualifying event. If you fail to enroll in a health insurance plan within 60 days, you must wait until the next open enrollment period or go through another qualifying life event which makes you eligible for another special enrollment period.

Given the penalty for being uninsured, it is important to maintain creditable health insurance coverage.

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