Enrollment for ACA

Insurance Enrollment Periods

Enrollment in Insurance means the annual window when individuals can buy a Health Insurance Plan directly through the Health Insurance Marketplace.

During this window, individuals can sign up for Health Insurance Plans, and adjust their current or cancel a plan. If this window is closed, you will have to wait until the next enrollment window to make any changes.

These periods are;

• Open Enrollment and
• The Special Enrollment Periods (SEPs).

Open enrollment for ObamaCare

This is the annual period when an individual can enroll in an Employment-based Plan, Medicare, or ACA-Compliant Health plan (ObamaCare). In general, only enrollment into any non-group Health Plan is allowed during the Open Enrollment Period.

The Open Enrollment Period is there to discourage adverse selection – these are situations where people only sign sick people sign up for health insurance healthy! This greatly skews the risks facing Health Insurance Providers.

When is open enrollment for ObamaCare

The Federal Open Enrollment Period goes for 45 days (November 1 through January 15). This may vary in length when it comes to states as they can set their own permanent extended Open Enrollment Periods (and as long as it is not earlier than December 15).

1. California: Nov 1 to Jan 31 (renewals begin Oct 1)
2. Colorado: Nov 1 to Jan 15
3. Connecticut: Nov 1 to Jan 15
4. District of Columbia: Nov 1 to Jan 31 (Residents without coverage can enroll anytime through the COVID period)
5. Idaho: Oct 15 to Dec 15
6. Kentucky: Nov 1 to Jan 15
7. Maine: Nov 1 to Jan 15
8. Maryland: Nov 1 to Jan 15
9. Massachusetts: Nov 1 to Jan 23
10. Minnesota: Nov 1 to Jan 15
11. Nevada: Nov 1 to Jan 15
12. New Jersey: Nov 1 to Jan 31
13. New Mexico: Nov 1 to Jan 15
14. New York: Residents without coverage can enroll anytime through the COVID period; 2023 plans are expected to be available by Nov. 16, 2022
15. Pennsylvania: Nov 1 to Jan 15
16. Rhode Island: Nov 1 to Jan 31
17. Vermont: Nov 1 to Jan 15
18. Washington: Nov 1 to Jan 15

Exceptions to Open Enrollment Periods

• A new window to enroll may be available in the Special Enrollment Periods (SEPs) if you have Qualifying Life Events (QLE).
• For Employment based Covers, the employer decides when you can enroll or make changes to a current plan (usually Jan. 1 through Dec. 31).
• Members of Federally recognized tribes (American Indians and Alaska Natives) are allowed to enroll in Marketplace coverage throughout the whole year.
• Individuals with income up to 150% of the federal poverty level are allowed to sign up all year through.

Open enrollment dates for the last few years;

Although it’s usually scheduled for November 1 – January 15 in most states, it has varied to some extent over the years.

In the Federally-run Marketplaces, the following windows have been used previously:

• open enrollment for 2014: October 1, 2013, to March 31, 2014
• open enrollment for 2015: November 15, 2014, to February 15, 2015
• open enrollment for 2016: November 1, 2015, to January 31, 2016
• open enrollment for 2017: November 1, 2016, to January 31, 2017
• open enrollment for 2018: November 1, 2017, to December 15, 2017
• open enrollment for 2019: November 1, 2018, to December 15, 2018
• open enrollment for 2020: November 1, 2019, to December 15, 2019
• open enrollment for 2021: November 1, 2020, to December 15, 2020
• open enrollment for 2022: November 1, 2021, to January 15, 2022
• open enrollment for 2023: November 1, 2022, to January 15, 2023

Special Enrollment

Once the Open Enrollment Period is closed, most individuals cannot enroll (or make changes to their current plan) in Marketplace Health Plans until the next Open Enrollment period.

However, you can still get health insurance using Special Enrollment Periods (SEPs) if are experiencing certain changes in your life during that year (Qualifying Event). A special 60-day window is opened (outside of the Open Enrollment Period) to enroll in Marketplace Health plans effective the date of change in circumstance.

Qualifying Events include:

• Household changes( marriage, divorce, loss of a family member, or birth/adoption)
• Becoming a U.S. citizen
• Involuntary loss of other health coverage (through loss of jobs etc.).
• Change in address (especially when you had previous coverage, but move to a new area with different plans)).

Special Enrollment Periods are typically 60 days long and will allow you to purchase major medical insurance.

Voluntary Exits from the current cover

Voluntarily exiting from your coverage does not qualify an individual for the Special Enrollment Period unless they clearly demonstrate a decrease in household income (drop in estimated household income) or a change in their previous coverage to make them eligible.

Taxes and Cost Sharing

During the Special Enrollment Period, individuals may qualify for both a Premium Tax Credit and a cost-sharing reduction. This helps in reducing the premiums and total out-of-pocket costs.

Lastly, you can still get coverage for the rest of the year if you qualify for Medicaid, the Children’s Health Insurance Program (CHIP).

BOTTOM LINE

If your current plan is no longer on offer and you didn’t select a new one, you will be auto-enrolled on a new plan of the same price. Most people never bother to verify and by the time they realize this, the open enrollment period is over, and the new plan (whether it suits their needs or not) is already in effect (after Jan. 1).

Please note;

• In some instances, the Open Enrollment Period can be extended, or the eligibility requirements for the Special Enrollment Period may be amended.
• During an open enrollment period, you cannot be turned down for ACA-compliant health insurance because of preexisting conditions.

Evaluate your plan options in advance for changes each year. Look specifically at;

• the affordability of monthly premiums, Copays, and deductibles,
• If cystic fibrosis and transplants are covered,
• Medications covered and
• Prior authorization for drugs or services.