Special Enrollment Periods
Know Your Options Outside Open Enrollment
We are now outside the open enrollment period. The next open enrollment period for 2025 coverage is not until November 1, 2024. Until then, the only way for you to get a traditional health insurance policy is if you qualify for a special enrollment period.
If you are without coverage and do not qualify for a special enrollment period, you can enroll right away in a short-term medical plan or other alternative coverage options like a healthshare program.
Special Enrollment Periods Following a Qualifying Event
Most Americans are required to have ACA-approved health insurance coverage or face a tax penalty. If you don’t have health insurance coverage through your employer, you can purchase a plan during the ACA open enrollment period that occurs around the end of the year. But what happens when you are outside of that period?
Outside of an open enrollment period you have few options to get health coverage – unless you experience a qualifying event that entitles you to a special enrollment period.
A qualifying event is a defined event or “triggering event” that results in an individual being given a specific time period to enroll for health insurance. A special enrollment period is a time period that is triggered by a defined event or “qualifying event” that allows an individual to enroll for health insurance.
The following is a list of the most common qualifying events:
Marriage or Divorce
Misconduct by an exchange or marketplace navigator, agent/broker, insurance representative, or health plan during enrollment
Earn less than 150% of the federal poverty level
Errors or contract violations that occur and are noted by the insurance exchange or state marketplace
Loss of health coverage (such as losing insurance due to loss of a job or becoming ineligible for Medicaid)
Becoming newly eligible or ineligible for advance premium tax credits or cost-sharing
Addition of a dependent (including birth of a child, adoption, or having a child placed in your custody)
Newly gained American citizenship
Permanent move to an area with different qualifying health plans (you must have had qualifying coverage for at least one of the 60 days prior to your move)
How Do Special Enrollment Periods Work?
Following a qualifying event, you typically have 60 days from the date of the event to seek new health insurance coverage. A qualifying event such as getting married, losing a job, or having a baby could also change your eligibility for premium assistance.
If you’ve been notified in advance that you will be losing your health insurance coverage, some special enrollment periods begin 30 days prio r to the termination date of your plan and last for 30 days after your plan terminates. Your Personal Benefits Manager can help you determine exactly when your special enrollment period begins and ends.
HSA for America Personal Benefits Managers are available to assist you with finding a health plan in your area and can help you apply for a premium subsidy if you qualify. ACA-approved plans are guarantee-issue, so you can’t be denied coverage due to a pre-existing illness.
If you voluntarily drop your insurance plan or do not pay your premiums, this does not allow you to qualify for a special enrollment period. You will have to wait until the next enrollment period to choose a new plan or consider alternative health care options such as a short-term health plan or a healthshare program.
More information: Getting Health Insurance Outside Open Enrollment: The Low Income Special Enrollment Period
Contact an HSA for America Personal Benefits Manager at 800-913-0172 to see if you qualify for a special enrollment period and to apply for coverage, including premium assistance if you qualify.
Getting a Health Plan When You Don’t Qualify for a Special Enrollment Period
Maybe you were unable to pay your premiums, or maybe you just weren’t able to get coverage before the open enrollment deadline – how do you get covered now? There are few options at this point, but your best option is likely a short-term health plan or go with a low-cost healthshare program.
Short-term plans are less expensive than traditional plans, and you can be covered as soon as 24 hours from the time you apply. Click the link below to run an instant quote and apply online:
Healthshare programs allow you to legally opt out Obamacare by choosing a completely different strategy for the coverage of your medical bills. Healthshare programs are backed by faith-based groups, and typically require that you agree to certain beliefs held by the members of the group in order to qualify for membership.
You must be in fairly good health to qualify, but you can sign up for membership at any time of the year, making these plans an excellent alternative outside of the Open Enrollment Period. Because they can often save you as much as 50% off your monthly cost for medical expense coverage, they’re actually a great option any time of the year!
Want to know more about how you can benefit from a Health Savings Plan?
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