If you missed the deadlines and extensions to sign up for a health care plan under the Affordable Care Act (ObamaCare), you will have to wait for the next signup window on November 15th, 2014, to acquire a qualified health care plan through the exchanges – unless you qualify for a Special Enrollment Period.
You qualify for a Special Enrollment Period through experiencing one of the items on the list of special circumstances known as Qualifying Life Events.
These may be special time-dependent circumstances for larger groups, such as the extension for those who started to enroll before the March 31st deadline but could not complete the process, or the current window allowing those who were enrolled in the recently dissolved Pre-Existing Conditions Insurance Plan (PCIP) to sign up until June 30th. However, most Qualifying Life Events are life changes that happen to individuals at any time throughout the year that alter family status and/or affect the qualification or ability to get health coverage. These changes are:
- Marital Status – Getting married or divorced will generally qualify you for special enrollment – changing your coverage needs, premium requirements, and qualification for subsidies.
- New Child – Whether through birth or adoption, adding a new child to the family qualifies for the same reasoning as the marital status changes – anything that adds or subtracts to the number of eligible family members. Foster children and stepchildren also may apply.
- Death of a Spouse/Dependent – This situation also qualifies under the same logic as above.
- Relocation – A permanent move to a location where your health care options are different from your existing plan.
- Changes In Basic Status – You were not previously qualified or able to acquire a health-care plan, but now you are due to the change of status. Examples are gaining U.S. citizenship or being released from incarceration.
- Loss of Coverage – For example: changes that render you newly ineligible for Medicaid or the Children's Healthcare Insurance Program (CHIP), expired coverage under COBRA, losing a job, losing coverage through divorce, or being a member of a health care plan that is decertified.
Coverage loss must be involuntary and not through simple non-payment of premiums. If the coverage you lost did not qualify under the ObamaCare guidelines, you will not qualify for Special Enrollment – since you should have enrolled in a plan with better coverage by that point anyway.
- Tax Credit/Cost-Sharing Changes – If your income or status changes in a way that affects your eligibility for cost sharing reductions/tax credits, you may qualify for Special Enrollment. For example, a raise at work may knock you out of eligibility for tax credits you previously received. Conversely, a reduction to part-time status may allow you to qualify for economic assistance through the exchanges.
- Native American Status – If you are newly classified as a member of an Indian tribe, you may change plans one time per month.
- Errors/Violations – If you were enrolled or excluded from enrollment through an error of the exchanges or HHS, or your plan violated its contract with you, you qualify for Special Enrollment.
Other circumstances may qualify on a case-by-case basis.
Typically, the special enrollment period is 60 days after a qualifying life event, but for job-based events, the window may be 30 days.
The intent of Special Enrollment windows and Qualifying Life Events is to make sure that as many people as possible maintain coverage. If you qualify for one of these windows, don't fail to take advantage. Otherwise, you may leave yourself and your loved ones without sufficient health care coverage until next year's signup begins.