The Affordable Care Act’s enrollment window for purchasing health insurance this year in the Health Insurance Marketplace ended March 31. However, a Special Enrollment Period is open now for people with "life events," for example:
- A person becomes divorced and loses access to insurance through the former spouse’s plan
- A person permanently moves to another state or another county within a state that has different Qualified Health Plans (QHPs) from the prior location. The entire family is eligible to enroll even if no family member was previously enrolled in a QHP.
- A person marries. Both spouses are eligible to enroll even if neither was previously enrolled in a QHP.
- A child is born, adopted or placed with a family for foster care or adoption. All family members are eligible to enroll even if none were previously enrolled in a QHP.
- Loss of Medicaid or CHIP as a result of increased income or age or no longer qualified through pregnancy
- Employer terminates the company’s group insurance plan, replaces an existing plan with one that fails to meet minimum standards defined in the Affordable Care Act or reduces work hours such that an employee loses his or her insurance.
- A person loses a job or quits a job, and with that, loses his or her employer-based insurance. The person is eligible to enroll instead of selecting Cobra continuation insurance.
- Loss of insurance because a Cobra continuation plan expired
- A person who is already enrolled in Cobra continuation insurance can switch to a plan offered in the Health Insurance Marketplace. This option is only available until July 1.
- A spouse who is separated from the husband or wife as a result of domestic violence.
- A young adult reaches the age of 26 and, as a result, loses coverage through a parent's plan
For those who are currently enrolled in a Marketplace plan, certain "life events" must be reported. The more common examples are:
- Marriage – family size and income must be changed to account for the spouse and his or her children, if any. The spouse and children may be added to the insurance plan if they are not already insured.
- If a child is born, adopted or placed with a family for foster care or adoption, family size and income changes must be reported. The child can be enrolled in a QHP or in Medicaid or CHIP, whichever is applicable.
- A person becomes divorced. Changes in family size and income must be reported. A different QHP may be selected.
- A person permanently moves to another state or another county within a state that has different QHPs from the prior location. The person has the option to change his or her insurance plan.
Note that, for any enrollment, in order for an individual or family to qualify for a tax credit and possible additional cost sharing, projected income for the tax year 2014 must be at least 100 percent of the Federal Poverty Level (FPL). The FPL for various family sizes is as follows: individual: $11,490; couple: $15,510; family of three: $19,530; family of four: $23,550. Lawfully present immigrants are excluded from this requirement and qualify with incomes below 100 percent of the FPL.
Those already enrolled who must report "life changes" can contact the Health Insurance Marketplace at 800-318-2596 and ask to speak to a representative.
The same phone number can be used by anyone who wishes to enroll for any of the reasons noted above.