Open enrollment for health insurance coverage in 2014 through the Affordable Care Act (ACA) has ended, and the next time consumers can apply for coverage through an open enrollment period will be in November, for coverage that will be effective on Jan. 1, 2015.
There are, however, special circumstances, or "qualifying life events," that will allow some consumers to enroll in health insurance coverage outside of the open enrollment periods. The federal premium tax credits and cost-share subsidies that are available during open enrollment periods will also be available for qualified consumers during these special enrollment periods - but only when you act within a specific 60-day window of the event taking place.
So what kind of “event” qualifies? Getting married and having a baby are two of the most common examples of qualifying life events, but not all qualifying life events are celebratory occasions. Losing your job, suffering a death in the family or moving to a different geographic location are also qualifying life events. These life changes can be emotionally taxing, so it’s important for people to know the options available to quickly and affordably secure the peace of mind that comes with health insurance coverage.
If you lose your job or have a death in the family and your health insurance coverage is affected, you can enroll in new coverage on the health insurance marketplace within 60 days. Similarly, if you move to a new state, or to a new location within the same state where different insurers are offering coverage - in Pennsylvania, for example, the insurers offering coverage in the western part of the state differ from those offering coverage in the eastern part of the state – that is also considered a qualifying life event. You will be given up to 60 days following the date of your move to enroll in new coverage on the health insurance marketplace.
There are also a handful of additional special enrollment periods. If you are currently enrolled in a plan that started before Jan. 1 and you lose qualifying coverage sometime this year, you will have a special enrollment period to sign up for new coverage. This special enrollment period generally runs from 60 days before your plan ends to 60 days after your plan ends.
To make sure that you don't have a gap in coverage, you must enroll in a new plan by the 15th day of the last month of your current plan's coverage. For example, if your current coverage ends on June 30, you must enroll by June 15 when enrolling on the health insurance marketplace for your new coverage to begin on July 1.
It's important to remember that if you don't enroll in coverage during the special enrollment period for a qualifying life event like the ones mentioned above, you won't be covered for the rest of the year. The ACA requires that most people have health insurance, and if you're not covered, you may have to pay a penalty.
But beyond the penalty, there are so many good reasons to have health insurance, such as having peace of mind if you get sick or have an accident, accessing the preventive services and screenings that are covered, and possibly getting help paying for your coverage and out-of-pocket expenses. Don’t miss out on these important benefits because you aren’t aware your circumstance is a qualifying life event.
If you need more information about qualifying life events, special enrollment periods, tax credits, contact your local Blue Cross Blue Shield company.
Suzanne M. Fletcher is program lead for health care reform and vice president of Finance and Administrative Services for Blue Cross of Northeastern Pennsylvania