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Special Enrollment Periods for the Marketplace

Wednesday, October 28, 2015
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If you need health coverage and want to enroll in a Marketplace plan, you typically have to do so during the annual open enrollment period. For 2017 coverage, the open enrollment period is Nov. 1, 2016, through Jan. 31, 2017.

Open Enrollment for 2016 health coverage ended January 31, 2016.

If you don’t have health coverage and you are outside the open enrollment period, you may be able to take advantage of a special enrollment period for qualified health plans on the Marketplace. Special enrollment periods are available only if you meet certain requirements. However, if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can enroll in those programs at any time of the year—you can begin an application at healthcare.gov and it will let you know whether you qualify and what you need to do to enroll.

If you do not have minimum essential health coverage, you may have to pay a fee unless you qualify for an exemption. For information on exemptions from the penalty, visit www.healthcare.gov/exemptions.

Qualifying Life Events

If you experience a qualifying life event, you are eligible to enroll in a Marketplace plan during the special enrollment period. You usually have up to 60 days from the date of the qualifying event to enroll in a new plan. Qualifying life events include the situations described below.

  1. Your personal circumstances change, including:
  • Marriage
  • Birth of a child
  • Adoption or placement of child for adoption or foster care
  • Gaining citizenship
  • Moving residence outside your insurance plan’s service area
  • Leaving incarceration
  1. You experience an involuntary coverage change, which may include:
  • Losing health coverage due to situations such as job-based coverage ending, aging off a parent’s plan at 26, losing coverage through divorce or similar events. However, voluntarily giving up coverage, or losing coverage that is not minimum essential coverage, will NOT qualify you for special enrollment
  • Losing eligibility for Medicaid or CHIP
  • Becoming eligible for COBRA or having COBRA coverage expire (voluntarily dropping COBRA coverage is not a qualifying life event)
  1. You gain status as a member of an American Indian tribe—members of federally recognized American Indian tribes can sign up for or change plans once a month throughout the year.
  2. For individuals already enrolled in Marketplace coverage, a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions can make you eligible to elect a change in coverage.

Enrollment during Special Enrollment Periods

If you think you qualify for a special enrollment period, healthcare.gov recommends that you complete a Marketplace application, which will guide you through the enrollment process if you are eligible.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.

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