Understanding Qualifying Events Under the Affordable Care Act
The open enrollment period for obtaining health insurance for the year 2016 ended on January 31. And, after that date in every other state but Nevada, compliant plans are no longer available for purchase.
If you weren’t able to obtain health insurance during this year’s open enrollment, then you will have to wait until the next open enrollment period, which begins November 1, 2016. If you purchase health insurance during the upcoming open enrollment period, your coverage will be effective starting January 1, 2017. Like this year, the open enrollment period for obtaining insurance for next year ends on January 31, 2017.
Of course, the Affordable Care Act does allow certain people the benefit of obtaining compliant plans after the open enrollment period has ended. Those who qualify must meet certain requirements categorized as qualifying events.
The 9 Qualifying Events
There are currently nine life circumstances which are considered qualifying events under the Affordable Care Act. They include:
If you missed the open enrollment deadline for one of the reasons above, then you will probably qualify for a special enrollment period. Schnitzer-Slate is a leading health insurance provider Wilmington NC and we can help. We offer a wide range of Blue Cross Blue Shield North Carolina insurance plans for every lifestyle need and budget. Even if the open enrollment deadline has passed, we can help you get the health care coverage you need to still comply with the ACA’s laws.
Just give Schnitzer-Slate a call today at 910-392-7020. One of our agents will help you find an affordable healthcare plan for your unique health care needs.
If you weren’t able to obtain health insurance during this year’s open enrollment, then you will have to wait until the next open enrollment period, which begins November 1, 2016. If you purchase health insurance during the upcoming open enrollment period, your coverage will be effective starting January 1, 2017. Like this year, the open enrollment period for obtaining insurance for next year ends on January 31, 2017.
Of course, the Affordable Care Act does allow certain people the benefit of obtaining compliant plans after the open enrollment period has ended. Those who qualify must meet certain requirements categorized as qualifying events.
The 9 Qualifying Events
There are currently nine life circumstances which are considered qualifying events under the Affordable Care Act. They include:
- An Error or Problem With Enrollment – If you applied for coverage during the open enrollment period, but experienced an error or problem with your enrollment, then the exchange will resolve the problem and properly enroll you in your plan of your choosing even after open enrollment has ended.
- You Became a Permanent Citizen of the United States – If you become a U.S. citizen after the open enrollment period has ended, then this if a qualifying event, but one that only applies within the exchanges. Carriers who sell insurance outside of the exchange may or may not grant these privileges to new citizens.
- You Permanently Relocated – If you moved to a different state or an area where the qualified health plans are different, then you will need to re-enroll in a plan in your new location. As a result, you will be granted a qualifying event, but only if you already had the minimum essential coverage active for at least one of the 60 days prior to the move (exceptions include people moving back to the U.S. from abroad, people newly released from jail, or those who were previously in a coverage gap in a state that did not expand Medicaid).
- You Got Divorced – If you lost your health insurance as a result of divorce, then you will qualify for an extended special enrollment period. If you have children as part of a custody agreement, then coverage can be backdated to the date the court order was issued.
- You Got Married – If you got married after the open enrollment period, then this is a qualifying event and you are granted a 60-day window to acquire health insurance. The countdown begins on your wedding day and your policy’s coverage will begin the first of the month after your application is accepted and approved.
- You Became a Dependent or Gained a Dependent – If you became a dependent or you gained a dependent after the open enrollment period has ended, then you qualify for a special extended enrollment period. Your or your new dependent’s coverage will be back-dated to the date that the change in status occurred. If you are a new parent, then you are granted the option to choose a later start date if preferred.
- Your Employer Changed Your Plan and It is Now Unaffordable or It Doesn’t Meet Minimum Value Requirements – Under the Affordable Care Act, an employee is not supposed to pay more than 9.66 percent of their income for their portion of their health coverage. If your employer changes your plan and you are forced to pay more than 9.66 percent, or the new employer-provided plan doesn’t meet the ACA minimum coverage requirements, then you will qualify for a special enrollment period in which you can select a different, more affordable plan.
- Your Existing Plan is Set to Renew Outside of the Open Enrollment Period – If you have a current health care plan that is set to renew outside of the open enrollment period, then this is eligible to be classified as a qualifying event. In order to qualify however, the plan must be renewed, not terminated by you, the policy holder. If the plan is being terminated by the policy provider and you are outside of the open enrollment period, then you will qualify for a special enrollment period.
- You Involuntarily Lost Your Existing Coverage – If you involuntarily lost your prior health coverage, you will qualify for a special enrollment period as long as your prior policy provided the minimal essential coverage as recognized under the Affordable Care Act. The only case in which someone can be approved for a special enrollment period after losing a plan that didn’t meet the minimal essential coverage is the loss of pregnancy-related Medicaid coverage. It is important to note that your special enrollment period starts 60 days before your old coverage terminates. This is designed to help individuals prevent a lapse in coverage.
If you missed the open enrollment deadline for one of the reasons above, then you will probably qualify for a special enrollment period. Schnitzer-Slate is a leading health insurance provider Wilmington NC and we can help. We offer a wide range of Blue Cross Blue Shield North Carolina insurance plans for every lifestyle need and budget. Even if the open enrollment deadline has passed, we can help you get the health care coverage you need to still comply with the ACA’s laws.
Just give Schnitzer-Slate a call today at 910-392-7020. One of our agents will help you find an affordable healthcare plan for your unique health care needs.