7 Life Events That Qualify You for Special Enrollment Period
Under the Affordable Care Act you can usually only buy a health insurance plan, apply for subsidies to help pay for coverage, or switch plans is during the annual open enrollment period.
The purpose of this rule is to keep people from waiting until they are sick or they suspect they may be sick to purchase health insurance.
The open enrollment period for 2015 health insurance coverage ended in February.
If you don’t have health insurance and need coverage for 2016, the next time you can purchase it from the federal marketplace will be during the next open enrollment period, which runs from November 1, 2015 to January 31, 2016.
The exception for this is if you experience certain qualifying life events which typically gives you 60 days from the event date to purchase marketplace insurance.
Here are seven of the most common Life Events that qualify you for a special enrollment period.
1. Leaving your job
If you have insurance through your employer and you either quit or lose your job, you qualify for a special enrollment period.
If you apply for insurance through the health insurance marketplace, keep in mind that a change in income may mean you can receive a subsidy that covers all or most of your health insurance premium.
Be aware, however, that if your total income for the year is higher than you estimate when applying for the subsidy, you may have to pay some or all of the tax credit back when you file your taxes.
Another option is to stay on your employer’s policy under COBRA. However, if you sign up for COBRA and then decide to cancel it before it ends, you do not get another special enrollment period.
2. Getting married
When you get married, you qualify for a special enrollment period. You have 60 days from the date of your wedding to buy health insurance, change to a different plan, or add your spouse to your existing plan.
3. Getting divorced
What happens if you’ve been getting health insurance through your spouse’s policy and you get a divorce?
You have 60 days to find a new policy (through the marketplace or privately) during your special enrollment period.
Assuming your income is lower as a single person, you may qualify for a full or partial subsidy for your health insurance premiums.
4. New dependents
If you gain a dependent you qualify for a special enrollment period.
For example, if you have a baby, take in a foster child, adopt a child, or your parent or another dependent comes to live with you, you have a 60-day window to add that person to your policy or change policies.
If you don’t have health insurance when you add the dependent, you can also purchase it during this period.
Moving doesn’t necessarily qualify you for a special enrollment period. If you don’t have insurance and you move a few blocks away, for example, it’s not a qualifying Life Event.
However, most health insurance plans are specific to a particular geographic area.
If you move out of the area currently served by your plan, you have 60 days to find a new policy.
6. Change in citizenship status
Becoming a U.S. citizen or legal immigrant in the U.S. during the year is considered a qualifying Life Event.
As a U.S. citizen or legal immigrant, you can buy health insurance through a government-sponsored marketplaces and you may even qualify for subsidies to help offset the cost of premiums.
7. Leaving incarceration
Leaving jail or other incarceration qualifies for a special enrollment period, during which time you can purchase health insurance.
Why does having health insurance for 2015 matter? You could face a penalty when you file your federal tax return next year if you don’t meet requirements for minimum essential coverage.
In 2015, the fee increases to the greater of $325 per person or 2 percent of household taxable income.
Remember, you can enroll in state Medicaid or the Children’s Health Insurance Program (CHIP) any time of year. (You don’t have to wait for an open enrollment period.)
While there are many life changes that qualify for a special enrollment period, voluntarily ending insurance coverage is not a qualifying event.
If you think you are eligible for a special enrollment period, you must apply through a government-sponsored marketplace. If your special enrollment period is denied, you can appeal the decision.