If you missed Open Enrollment, you may still be able to get health coverage.
The open enrollment period to buy major medical insurance through an Exchange established by the Affordable Care Act (ACA) ended on March 31, 2014. Most people who are uninsured and did not purchase a plan either through an Exchange or through the traditional insurance market will be subject to a tax. However, missing the open enrollment period does not necessarily mean that the uninsured won’t be able to get coverage in 2014. A few options are available for accessing health insurance outside of open enrollment.
If You Started Your ACA Application Already…
First, the federal government announced that individuals who started their applications for insurance through an Exchange but didn’t complete the applications by March 31st can get coverage. If you started your application before March 31st, finish the process by April 15, 2014, and you may still get covered.
Medicaid and CHIP Have No Enrollment Period
Second, open enrollment does not apply to Medicaid. If an individual or family qualifies for Medicaid based on their income they can get covered at any time. There is also no limited enrollment period for the Children’s Health Insurance Program (CHIP). Medicaid is the largest source of medical and health-related services for people with low income (typically between $12,000 and $16,105 per year for an individual) in the United States, eligibility varies state to state.
Qualifying Life Events That Extend the Deadline
Third, individuals can sign up for coverage outside of open enrollment if they have a qualifying life event. Qualifying life events that create a special enrollment period include:
- Getting married
- Having, adopting, or gaining custody of a child
- Permanently moving to a new area that offers different health plan options
- Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified).
- For people already enrolled in Exchange coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.
The ACA also allows for enrollment outside of the open enrollment period for what is called an exceptional circumstance. These include:
- An unexpected hospitalization or temporary cognitive disability
- A natural disaster, such as an earthquake, massive flooding, or hurricane
- A planned system outage, such as Social Security Administration system outage.
* Each state (and the individual health insurance plans offered in those states) is able to determine what additional life qualifying events allow an individual to enroll in a health plan outside of the open enrollment period. Check the website for your state Exchange for detailed information about what is accepted as a qualifying life event.
This article is for general information only. Neither Transamerica nor Transamerica Center for Health Studies provides personal legal, health, or insurance advice. Readers should seek qualified personal assistance if they have personal health insurance coverage questions.
About Transamerica Center for Health Studies SM
The Transamerica Center for Health Studies (TCHS) is a division of the Transamerica Institute, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.