Can I Enroll in Coverage After Open Enrollment?

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Generally speaking, enrolling in Affordable Care Act (ACA) health insurance coverage is restricted to the annual open enrollment period. For this year, open enrollment began on November 1, 2016 and is scheduled to end on January 31, 2017.

Mark your calendars with these important Open Enrollment Dates & Deadlines

If you missed this period, under the health law, you must experience a qualifying life event (QLE) to enroll in a new plan or change your existing coverage. In most cases, a qualifying life event will trigger a 60-day special enrollment period (SEP), allowing you to change your existing coverage or apply for a new plan.

This article provides a list and explanation of qualifying life events.

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Types of Qualifying Life Events

According to Healthcare.gov, there are 4 basic types of qualifying life events. The following shows some examples, but is not a full list of QLEs.

Loss of health coverage
  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Turning 26 and losing coverage through a parent’s plan
Changes in household
  • Getting married or divorced
  • Having a baby or adopting a child
  • Death in the family
CHANGES IN RESIDENCE
  • Moving to a different ZIP code or county
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing
OTHER QUALIFYING EVENTS
  • Changes in your income that affect the coverage you qualify for
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • Leaving incarceration (jail or prison)
  • AmeriCorps members starting or ending their service

I’ve Experienced a Qualified Life Event. Now What?

A 60-day special enrollment period is offered to those individuals that experience a qualified life event, such as birth, adoption, the birth of a child, or others listed above. This means that during this time, you must sign up for coverage, shop for a new plan, or make necessary modifications such as add or removing your children or spouse from your policy. If you do not do so, within this period, you will be required to wait until the next open enrollment period in November to acquire coverage.

 

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon, Inc. (dba Welltheos).

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Yvonne Villante
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Yvonne Villante

Senior Research Manager, Healthcare Reform at Welltheos
As our Senior Research Manager, I work closely with our Solution Architect, Product Management, and Sales teams. My role centers around competitive and market analyses, constructing premium content (whitepapers, research briefs, infographics), curating stories for our newsletters, and blogging.

I earned my BAA from the State University of New York at Stony Brook and MBA in Healthcare Administration from the University of Ohio (Athens). I was born and raised on Long Island, NY and enjoy capturing what the island has to offer through photography.
Yvonne Villante
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