Open Enrollment versus Special Enrollment in the Health Insurance Marketplace®
If you don’t currently have health insurance or have a plan but want to change it, what are you waiting for? Well, you might be waiting for the enrollment period to open up so you can purchase a plan through the Health Insurance Marketplace. This is the place to go if you want to dramatically lower the dollar amount of your premium through tax credits. Learn more about the Health Insurance Marketplace below, including the annual open enrollment period and when you might qualify for a special enrollment period outside of the regular open enrollment period.
What Is the Health Insurance Marketplace?
The health insurance marketplace is a government-run exchange where people can shop around for different health insurance plans, select a plan, and enroll. Small businesses can use the marketplace to provide health insurance for their employees, and individuals and families can apply for private coverage through the marketplace. By providing information regarding your household income and other household information, the marketplace will calculate the size of premium tax credits you qualify for or let you know if you qualify for insurance coverage through programs like Medicaid or CHIP (the Children’s Health Insurance Program).
The Health Insurance Marketplace run by the federal government can be found at www.HealthCare.Gov. However, many states have established their own health insurance marketplaces or health insurance exchanges, so if you live in one of those states, you would go to your state marketplace to choose a plan to enroll in. In California, for example, the health insurance marketplace is called Covered California, which can be found at www.coveredca.com. You can always start at HealthCare.gov, and they will direct you to your state exchange if applicable.
The Health Insurance Marketplace can be a great way to shop for insurance and find a plan that meets your needs. Marketplaces like Covered California give you access to plans offered by several different health insurance companies, and each one offers different levels of plans that meet your needs. Whether you are looking for lower premiums with higher deductibles, lower deductibles with higher premiums, assurance that all your medications are covered, low-cost or no-cost doctor visit co-pays, or you want to see a specific doctor or doctors who are in-network, you can find the plan that is right for you through the marketplace.
Based on your income and household size, you can qualify for hundreds or even thousands of dollars of tax credits every month. These credits can drastically lower the monthly premium you have to pay out of pocket and can make just about any plan affordable.
The annual open enrollment period for applying to the Marketplace starts on November 1 and ends on December 16. This is the period to either enroll for the first time or change your plan for next year. If you enroll during this period, your new coverage will start on January 1. Technically, you have until January 31 to enroll, although your coverage obviously won’t be effective starting January 1 in that case. This extended date does nevertheless hold out hope for procrastinators.
If you miss the open enrollment period, you’ll have to wait until the next November to enroll in a plan or change your current plan, unless you qualify for a special enrollment period.
Special Enrollment Periods
Typically, life events such as marriage, birth, adoption or foster care, divorce or separation, death, a change in residence, a loss of health insurance, or an offer from your employer to help with coverage are all qualifying events that could open up a Special Enrollment Period for you. A 60-day special enrollment period opens for you in any of the following situations:
- Change in household – You got married, had a baby, adopted a child, had a child placed with you for foster care, got divorced or legally separated and lost health insurance, or someone on your Marketplace plan died.
- Change in residence – You moved to a new home in a new ZIP code or county, you moved to the U.S. from a foreign country or U.S. territory, you are a student moving to or from the place where you attend school, you are a seasonal worker moving to or from the place where you live and work, or you are moving to or from a shelter or other transitional housing.
- Loss of health insurance – You or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days. If you lost coverage since January 1, 2020, but couldn’t enroll sooner because of COVID-19, you might still be able to enroll even if it’s been more than 60 days.
States that run their own exchanges might have other criteria for special enrollment besides the ones mentioned above. For example, Covered California has special enrollment periods for people affected by wildfires, released from jail or prison, returning from active military service, turning 26 years old, victims of domestic abuse or spousal abandonment, and many other reasons.
The special enrollment period lasts for 60 days from the date of the life event. If you know that an event is coming within 60 days, you can submit your application within that timeframe before the event happens and hopefully avoid a gap in coverage, such as if you were receiving coverage through your employer but expect to lose it in the coming months.
Special Enrollment Period for COVID-19
Even without one of the life events described above, anyone can still enroll in a plan or change their plan under the Special Enrollment Period created due to COVID-19. This Special Enrollment Period lasts until August 15, 2021. If your state operates its own exchange, check to see whether they established a different window for this special enrollment period.
On a final note, if you qualify for Medicaid (Medi-Cal in California), you can apply for coverage through the Marketplace any time throughout the year. You don’t have to apply separately to Medicaid, either. By applying for insurance through the marketplace, they will let you know if you qualify for Medicaid, and you can apply for Medicaid and enroll in a health plan on the spot. If through the application process it becomes clear that you don’t qualify for Medicaid, then you’ll have to wait until the next open enrollment or a special enrollment period that applies to you.
If you don’t have health insurance now or if you lose employer-provided insurance, the Health Insurance Marketplace can be a great option for robust, affordable coverage. From your applicable federal or state marketplace website, you can get in touch with an agent, broker or person specially trained to assist you in applying for coverage. This is recommended, since the way you report your information determines the size of the tax credit you get to offset your premiums.