If you missed the open enrollment period or will find yourself without health insurance at some point this year, these two words will be your new best friend, "special enrollment." These special enrollment periods are triggered by "qualifying events."
You might be saying, "That's great, Joey. What does that mean?"
Don't worry, keep reading and I will take care of all your questions.
What's a Special Enrollment?
This is simply a window that opens to allow you to enroll (sign up, buy) an individual health insurance policy after the initial open enrollment period has closed (for this first year it's March 31st).
A special enrollment period is triggered by qualifying events that are required by law. Most of the time, special enrollment periods last 60 days from the time of the qualifying event.
That means from April 1 until September 30 this year, the only way you're going to be able to get health insurance is through a special enrollment.
What Are the Qualifying Events?
There's a decent list of qualifying events that can trigger these special enrolment periods. Here's some of the most likely or popular, I guess you could say, events you will run across.
- Losing minimum essential health coverage
- Getting married
- New child
- Change in income
- Medicaid or CHIP
- Cobra expiration
- Health plan decertified
In order for one of these events to open (unlock) your special enrollment period, you will have to submit some type of formal documentation to the health insurance company you are seeking coverage from to verify the "specialness" of your event.
NOTE: I still haven't received a ton of details on the type of documentation needed or the process in which it can be submitted, however an example could include a letter from your current insurer stating loss of coverage, marriage license or birth certificate.
Wait, What's Open Enrollment?
Open enrollment is simply the mandatory time the government and health insurance companies have set to allow you to apply/buy/enroll/renew your health insurance.
When Can You Apply During These Special Enrollments?
If you were to take what I said above word for word, you would have 60 days from the qualifying event to find and apply for new coverage.
What If You Don't Want to Wait to Apply?
The details on this are still a bit of a moving target, but right now it appears you can apply several months before you are about to lose coverage to have your new health insurance ready to go. All you need to do is indicate the effective date (when the policy should start) you will need.
An example of that would be, if someone needed coverage starting June 1st, they could submit the application now indicating the 6/1 effective date on the application along with proof of the qualifying event to the health insurance company.
What Happens If You Don't Pay for Your Health Insurance, is That Loss of Coverage?
The simple answer, no.
Not paying or forgetting to pay your health insurance premium is not considered a "loss of minimum essential health coverage."
If your health insurance canceled due to non payment after open enrollment, you will have to wait until next open enrollment to replay if it's not reinstated in time.
The Bottom Line
This whole, "open" and "special" enrollment thing takes a little getting used to, but it's in your best interest to figure this new system out as it's the new normal when it comes to buying health insurance.
If you need health insurance outside of the normal open enrollment period, you're going to want to make sure you've got a qualifying event to fall back on. If not, you will have to make sure you apply during the normal open enrollment period.