Obamacare Countdown – Step 5

July 15, 2013

The difference between open enrollment and a qualifying event

The new open enrollment period when you can start to shop for newly reformed health insurance plans is currently scheduled to begin in October 2013 and run through March 2014. Open enrollment is the time of year that the Federal Government requires insurers to accept applications from qualified individuals applying for a health insurance plan.Open enrollment--don't wait in line

If you don’t buy health insurance during open enrollment, you’re outside the government’s guaranteed eligibility period. As a result, it may be more difficult to buy it later unless you have a qualifying event. Without health insurance, you could face tax penalties, not to mention large medical bills if you get sick or injured.

Open enrollment

Insurance companies may elect to have additional open enrollment periods throughout the year, and state regulations may also create additional open enrollment periods. But, the new federal guidelines only guarantee one open enrollment period each year when you can apply for any plan available in the individual market.

This year, exchanges are scheduled to allow people to enroll during a six-month open enrollment period, which runs from October 1, 2013 to March 31, 2014 for coverage that is effective January 1, 2014 and after.

At the end of 2014, and the years after, the federal annual enrollment period is scheduled to run from October 15 through December 7. But it’s important to note that individual states and individual insurers may choose to have their own open enrollment periods at different times throughout the year.

2013 Schedule for Open Enrollment and Effective Coverage

Under normal circumstances, the Affordable Care Act makes it clear that an application submitted between the first and the fifteenth day of any month, must have coverage in effect by the first day of the following month. And, if you apply for coverage between the sixteenth and the last day of any month, your coverage should be in effect by the first day of the second following month.

Application submission date

Guaranteed effective date of coverage

October 1 through December 15, 2013

January 1, 2014

December 16 through January 15, 2014

February 1, 2014

January 16 through February 15, 2014

March 1, 2014

February 16 through March 15, 2014

April 1, 2014

March 15 through March 31, 2014

May 1, 2014

 

Qualifying events for special enrollment periods

The Affordable Act makes it clear that special enrollment periods, which fall outside of the annual open enrollment period, must be made available. A special enrollment period is would be a time when a “qualifying event” occurs that would make you eligible to enroll in a Qualified Health Plan outside of the annual open enrollment period.

What’s a qualifying event?

A qualifying event is an event that takes place in your life that would make eligible to qualify for a special enrollment period.

Here are a few examples of qualifying events:

  • Loss of Essential Health Coverage: If you lose, or have one of your dependents lose health coverage that meets minimum government standards.
  • Change of Family Structure: If you gain a dependent or become a dependent because of a marriage, death in the family, birth or adoption of a child.
  • Change Citizenship Status: If you become a U.S. citizen, national, or gain lawful status in the U.S.
  • Experience Government Error: If you lose, change or enroll in coverage because of an error committed by an officer, employee or agent of the Exchange or the Department of Health and Human Services as determined by the Exchange.
  • Change Subsidy Eligibility: If you are determined newly eligible or newly ineligible for subsidies (advance payments of the premium tax credit or cost sharing reductions).
  • Move to a New Coverage Area: If you permanently move to a new area and gain access to new qualified health plans.