What happens when the Health Exchange Marketplace “Open Enrollment Period” closes on March 31st? This is the next question as American’s struggle to understand and comply with the massive, complicated and ever changing provisions of the Patient Protection and Affordable Care Act (ACA) of 2010.  The ACA established the initial Open Enrollment Period - the period of time during which individuals who are eligible to enroll in a Qualified Health Plan can enroll in a Marketplace plan. For coverage starting in 2014, the Open Enrollment Period began on October 1, 2013 and was extended to March 31, 2014. The next Open Enrollment Period, for coverage starting in 2015, is currently set from November 15, 2014 to January 15, 2015.

After the open enrollment period ends individuals seeking insurance will no longer be able to qualify for premium tax subsidies or cost sharing unless you have a “Qualifying Life Event” which opens a “Special Enrollment Period”.  That doesn’t mean you can’t buy or renew an individual health plan with an insurance company outside the Marketplace.  It just means that the Marketplace is closed to you and so are the ACA subsidies until next Open Enrollment Period. However, you can apply anytime for Medicaid or CHIP coverage is you qualify. 

Qualifying Life Event…
Is a change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. Examples of qualifying life events are moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby).

So, Qualifying Life Events that create a Special Enrollment Period include:

• Getting married
• Having, adopting, or placement of a child
• Permanently moving to a new area that offers different health plan options
• Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.
• For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions

Special Enrollment Period…
Is a time outside of the Open Enrollment Period during which you and your family have a right to sign up for health coverage. In the Marketplace, you generally qualify for a Special Enrollment Period of 60 days following a Qualifying Life Event. If you don’t have a special enrollment period, you can’t buy insurance inside the Marketplace until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 30 days.

Medicaid and CHIP: Enroll any time
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time—there is no limited enrollment period for these programs. Medicaid and CHIP provide health coverage to millions of families with limited incomes. You can find out if you qualify for Medicaid or CHIP by filling out a Marketplace application or going directly to your state Medicaid agency.

Some states have expanded their Medicaid programs this year (WA state has, ID has not). If your state has expanded Medicaid, you’ll probably qualify if your income is below about $16,1050 for an individual or $32,913 for a family of 4. See if your state is expanding Medicaid.

 If your state isn’t expanding Medicaid you may still be eligible, especially if you have children, are pregnant, or have a disability. Every state’s eligibility rules are different. If it looks like you’re eligible for Medicaid or CHIP, the Marketplace will pass along your information to your state agency, where you’ll be able to enroll. Find contacts for your state’s Medicaid and CHIP programs.

Source: US Health & Human Services, www.HealthCare.Gov – “How can I get coverage outside of open enrollment?”