09 Sep 2016

Qualifying Life Events for ACA: Reasons You May Still Be Eligible for Coverage

If you were unable to enroll in a health plan within the Open Enrollment Period (it ended January 31, 2016 for this calendar year), it means you won’t be able to get coverage for 2016. However, you may still qualify for a Special Enrollment Period if any of the following Qualifying Life Events apply to your situation:

  1. Involuntary loss of health coverage. Loss of minimum essential coverage can trigger a special open enrollment, including loss of pregnancy-related Medicaid coverage. Special open enrollment starts 60 days prior to termination date.
  2. Renewing outside of regular open enrollment (for individual plans). In May 2014, a provision was created to enable a special open enrollment for individuals renewing their health plan outside the regular enrollment period.
  3. Gaining a dependent (giving birth) or becoming a dependent. Coverage is back-dated to when the birth, adoption or placement in foster care took place although there is an option to choose a later effective date. The special window for enrollment is available to the new baby, newly adopted child and/or parents.
  4. Marriage. You have a 60-day open enrollment window starting on the day of your wedding and your policy takes effect on the first of the following month.
  5. Divorce. You can qualify for special open enrollment if you lose your health coverage because of a divorce. This special enrollment also applies to dependents who lose their health coverage due to the divorce of their parents.
  6. Becoming a US citizen. If you become a US citizen, you can qualify for a special enrollment.
  7. Permanent move to a new location. Moving to a new state will trigger a special enrollment period due to the variation in the health plans in every state. A move within a state may also be considered a qualifying event since some regions also vary in the provisions they offer.
  8. Government error. A problem with enrollment that was the fault of the exchange or its constituents may necessitate a special open enrollment to remedy the problem.
  9. Employee-sponsored coverage that reduces your benefits such that it becomes unaffordable or no longer provides minimum value. If the employee is required to pay over 9.66% of their income for their portion of the coverage, they can opt for a special open enrollment.

Other Insurance Options If You Don’t Qualify for Special Enrollment

If you don’t have any qualifying life event, you still have other insurance options. You can check if you qualify for CHIP or Medicaid. If you don’t qualify for any subsidized medical and health programs then you need to speak to an insurance provider outside of the marketplace. Take note however that some insurance options that are available outside the open enrollment are not compliant with the ACA and will not save you from having to pay Obamacare penalty costs.

The ACA doesn’t force you to buy medical insurance but you are required to pay a fee should you chose to go without medical coverage. If you don’t purchase health insurance within the open enrollment and you don’t have any qualifying life event, you will owe as much as 1/12th of the annual fee for every month you are without coverage.


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