The Basics of Open Enrollment for Obamacare

Affordable Care Act

The Basics of Open Enrollment for Obamacare

Published on July 10, 2014

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iStock_000008233744SmallWhen is the Obamacare open enrollment period?

The next open enrollment period for individual and family health insurance plans under the Affordable Care Act (ACA) begins November 1, 2015, and ends January 31, 2016.

What is an open enrollment period?

The Affordable Care Act’s open enrollment period is when consumers (and small businesses) can purchase health insurance plans that include ACA health reform provisions and required benefits. Coverage under these plans will begin on January 1 of the following year. The ACA’s provisions let you purchase health insurance with 10 essential health benefits, obtain government subsidies, and enroll without fear of being denied for pre-existing medical conditions.

Who needs to apply for coverage during open enrollment? 

The open enrollment period is most important for individuals and families who are not subject to an exemption or who do not already have qualifying coverage, such as employer-sponsored health insurance. So, if you have employee health insurance benefits, you do not necessarily need to enroll in a new plan during the Affordable Care Act’s open enrollment period.  Instead, you can choose to keep your employer’s group plan – if you do, make sure you pay attention to any open enrollment period your employer announces for your employer’s plan. If your share of your employer-sponsored health insurance monthly premium is too expensive, you may choose to opt out of your employer’s plan and purchase  your own qualified health plan during the ACA open enrollment period, possibly with subsidy assistance depending on your income level.

Will I be required to purchase a health insurance plan during this period? 

If you wish to enroll in an ACA-compliant health insurance plan, you will generally need to enroll during this ACA open enrollment period. In some cases, you can also buy ACA-compliant health plans outside the open enrollment period if you have a “qualifying life event” as explained below.  If you don’t have an ACA-compliant plan, you may be subject to a tax penalty unless you meet one of the exemptions.

What happens if I don’t purchase during the open enrollment period?

Outside of open enrollment, your ability to apply for health insurance may vary from state to state but will generally be limited to times when you have a “qualifying life event” as defined by the government. These are generally events such as the loss of employer-provided coverage, a marriage or divorce, a permanent move to a new area, or the birth or adoption of a child.

What if I miss open enrollment and don’t have a qualifying event?

You may be able to purchase a short-term health insurance plan, but these won’t meet the standards of the Affordable Care Act and your plan’s benefits will likely not be as comprehensive.

Where do I shop for health insurance during open enrollment?

During the open enrollment period, individuals and families can shop for ACA-compliant plans, including those that qualify for subsidies, at government-run health insurance marketplaces, such as www.healthcare.gov, or private-sector health insurance websites such as www.ehealth.com.

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