Qualifying Life Events can help you get coverage during Special Enrollment Periods for ACA (Affordable care act) health insurance
There are defined ‘lifetime events’ which ‘trigger’ a personal special enrollment period. This period is normally a 60-day window prior to the event and a 60-day window following the date of the ‘event’ itself. During this 120-period you may change your plan, enroll in a new plan, apply for the appropriate premium reliefs and subsidies.
For very good reasons [see footnote] US law requires all US residents to have continuous health insurance which meets the MEC (minimum essential coverage) guidelines. For most of us, that means ‘open enrollment’, an annual opportunity to plan our health insurance needs.
For equally good reasons the law recognizes that there are ‘lifetime events’ which necessitate enrolling for the first time, after a break or changing your coverage. These may occur at any time!
Each of these ‘lifetime events’ is strictly defined but some of the more obvious examples are: –
- Marriage or divorce
- Birth or adoption of a child
- A dependent is no longer eligible (usually when dependents reach 26 or qualify for Medicare)
- A significant change in your financial circumstances which affects your entitlement to premium tax credits
- A change of employment conditions (you gain or lose Employer/group coverage
- You move to a State that offers alternative conditions.
- Your insurers cannot provide the same coverage in your new location
- Your move results in more favorable conditions becoming available
There are some specific circumstances: –
- You become a US citizen
- You gain status a member of an Indian tribe
- You leave incarceration
Most of these events can be predicted, but anyone affected by one of these events should consider how their insurance needs will be affected and contact their Health Insurance Exchange as soon as possible. It may, for example, be appropriate to change a plan for example, from Bronze to Silver.
Individuals (and their dependents) who do not apply for Obamacare during a relevant ‘window’ will be uninsured until they enroll during the next ‘open enrollment’. They will be liable for all their healthcare and medical expenses.
Some health insurers offer short term cover but it may be relatively expensive, does not attract subsidies or premium tax relief. It will not count to your Medicare qualifying period.
NOTE: – Although SEPs (Special Enrollment Periods) apply specifically to health insurance they are a ‘wake-up’ call to review your complete insurance portfolio. E.g. Accident and Critical Illness. Talk to an insurance expert to know more.
OPEN ENROLLMENT coverage in 2020
The open enrollment period for individual and family health insurance coverage is
NOVEMBER 1st to DECEMBER 15th 2019
for coverage for you and your dependents to be effective
JANUARY 1st 2020
Why am I restricted to just 6 weeks each year to enroll?
For most people, this must seem like a very odd restriction, but there are very sound reasons. If you would like a brief non-technical explanation please see our footnote at the end of this article.
Footnote: – Open enrollment explained
The original Obamacare Act allowed for enrollment at any time and for carriers (Insurance companies) to have discretion when considering whom to insure.
The unintentional result was that people chose to insure themselves only when it seemed advantageous (e.g. they anticipated needing to make a claim). On the other hand, Insurance Companies were unwilling to accept clients with ‘pre-existing conditions’.
In an open health insurance marketplace, this resulted in ‘games playing’. Buyers (the general public) delayed taking out insurance and the need to pay monthly premiums as long as possible; sellers (the insurance companies) either refused health insurance to high-risk applicants or charged unacceptably high fees.
The aim of ACA (Affordable care act) is to spread the cost of ‘care and treatment’ over an individual’s lifetime and fairly across the population.
Consequently, Congress agreed
- That all US residents are legally required to have health insurance (which meets MEC) and must be valid from January 1st to December 31st. This does not prevent individuals from changing their insurer/exchange/metal plan. (OPEN ENROLLMENT)
- Health insurers cannot refuse insurance on the basis of pre-existing conditions nor renewals on the same terms.
Congress also stipulated that certain events (lifetime events) justified the need to review current contracts. These ‘events’ create windows during which the individual may modify their health insurance to meet changed circumstances.