This is part 3 in my series on the Affordable Care Act (ObamaCare). This time I want to take a look at the Enrollment Periods.
One of the provisions of the Affordable Care Act that most often confuses my clients are the Enrollment Periods. Prior to the advent of the ACA, anyone could purchase an individual insurance plan (as opposed to a group plan) any time they choose. All of that changed with the advent of the ACA. Now, with a few exceptions everyone must purchase their Qualified Health Plan (QHP) during the Open Enrollment Period.
November 15, 2014 Open Enrollment Starts.
Anyone eligible for the insurance can purchase a new QHP for 2015 (or stay with the one they have if already enrolled).
February 15, 2015 Open Enrollment Ends.
Last day for people to purchase a QHP for calendar year 2015.
February 16, 2015 to October 14, 2015 - Lock-out Period.
Except for special circumstances, no one may purchase a QHP.
October 15 to December 7 every year thereafter - Open Enrollment Period.
Certain “ Qualifying Life Events”can trigger a Special Enrollment Period(SEP). This is a 60 day period during the Lock-out Period where people are allowed to purchase a QHP. These events can include:
- Marriage or divorce
- Having a baby,
- Adopting a child, or
- Placing a child for adoption or foster care
- Moving your residence,
- Gaining citizenship,
- Leaving incarceration
- Losing other health coverage
- Loss of job-based coverage,
- The end of an individual policy plan year in 2014,
- COBRA expiration,
- Aging off a parent’s plan,
- Losing eligibility for Medicaid or CHIP,
- Similar circumstances.
- Change in income or household status that affect eligibility for premium tax credits or cost-sharing reductions
It is important to keep in mind that experiencing a loss of coverage because of one of these life events does not eliminate the Individual Mandate orthe Fee dictated by the law for not having coverage.
So that begs the question: “OK, so what happens if I miss open enrollment and either don’t have or don’t take advantage of an SEP?”In short, you simply cannot purchase a QHP and you will likely be required to pay the fee. That doesn’t mean that you are with out options to protect your family, but they won’t include a QHP.
This is just another reason why it is critical that you seek someone who is capable of guiding you as you Explore the Unknown.
Next time, we will try to clarify another provision of the ACA. As always, Keep Exploring…