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Health insurance plans which are compliant with the Affordable Care Act are intended to run from January 1st until December 31st without change. This rule is designed to make it impossible to change a plan in mid-year to cover additional risks or to avoid paying contracted premiums. There are supplementary plans and state or federal support to help meet these contingencies.
However, the ACA recognizes the need for plan changes in certain defined circumstances, a.k.a. Life Events which qualify you for a Special Enrollment Period (SEP) 2020 i.e. outside the period of Open Enrollment (November 1st_December 15th).
The events which qualify for health insurance under SEP can be divided into 3 categories.
Changes in household
Something happens to change the status of the individuals covered by your plan (see below).
Changes in residence
You move to another State, County or Zip Code.
(see our article, changes in residence? qualify for special enrollment period 2020)
Loss of health insurance coverage
If you or anyone lose qualifying health coverage through no fault of their own you may qualify for a Special Enrollment Period.
(see our article lost health insurance qualify for special enrollment period 2020)
Special enrollment period 2020- Changes in household
Getting Married
You have a window (60 days) which opens on the date of the marriage in which to enter a plan (or plans) that meets your new circumstances.
Note: – If either you or your spouse has a plan sponsored by your employer you should consider which plan best matches your joint needs. Generally, it will be an Employer scheme but you should make sure it meets your new circumstances.
Having Children
You may have a baby, adopt a child or place a child for foster care. In all these circumstances it makes sense to plan ahead but as above, you will have up to 60 days after the event to formalize your choice of plan.
Getting a divorce or legal separation (and losing health insurance coverage)
You may be on your spouse’s individual or group (Employer) scheme, and as a consequence lose your coverage (and that of any of your own dependents). As above, you have a window in which to finalize your new coverage.
Death
If someone on your plan dies and as a consequence, you lose your coverage (and possibly, your dependents too) you are eligible for a special enrollment period of 60 days following the event.
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