Did you miss the open enrollment period on your state’s Affordable Care Act (ACA) exchange? This article shows you how to get healthcare coverage.
It’s important to know that you need to get health insurance, or an approved Obamacare exemption, otherwise you might be uninsured until the next enrollment opportunity.
Without health insurance, you will likely face a tax penalty for the months you don’t have health insurance. You’ll need to budget for this IRS penalty, unless you take advantage of the Obamacare (ACA) Exemption shown below.
How To Get Health Coverage If You Missed ACA Open Enrollment In Your State
Ok.. so you missed open enrollment in the individual health insurance marketplace. Seven states are still allowing open enrollment in January 2018.
These States Extended Obamacare Open Enrollment Into January 2018.
Colorado: January 12
Minnesota: January 14
Washington: January 15
Massachusetts: January 23
DC: January 31
California: January 31
New York: January 31
Qualifying Events That Allow You To Enroll In Health Insurance
Here are the major qualifying events that trigger a special enrollment period in the individual health insurance market.
Loss of other coverage. The plan you’re losing has to be considered minimum essential coverage (ie, it can’t be something like a short-term plan or an accident supplement). And the loss of coverage can’t be a result of non-payment of premiums, rescission, or self-cancellation. So this applies in scenarios such as your health plan exiting the market, or loss of access to an employer-sponsored plan due to divorce, leaving a job, etc. (even if you’re offered COBRA, you still qualify for a special enrollment period during which you can purchase an individual plan instead). You’ve got 60 days before and 60 days after the loss of coverage during which you can enroll in a new plan. This special enrollment period applies to many people who lost coverage for various reasons at the end of 2015.
Becoming a dependent or gaining a dependent as a result of birth, adoption, or placement in foster care. If you have a baby, your special enrollment period starts the day the baby is born, and coverage can be backdated to the baby’s birth/adoption date. HHS has made a similar special enrollment period applicable to people whose family structure changes for other reasons, including divorce or death of a dependent (note that while the birth of a baby is a qualifying event, pregnancy is not – except in New York).
Marriage. If you get married, your 60-day special enrollment period begins the day of your wedding, and coverage will be effective the first of the month following your enrollment, regardless of the date you enroll.
Becoming a US citizen. New US citizens qualify for a special enrollment period, although it’s only applicable within the exchanges – off-exchange plans are not required to enroll people due to this qualifying event, although they can choose to do so.
A Permanent move to an area where different health plans are available. The move can’t be temporary, and at least some of the health plans available in the new area must be different from the ones that were available in your prior location. HHS clarified recently that moving into a hospital for treatment in a new location does not qualify as a permanent move. And as of July 2016, a permanent move will only trigger a special enrollment period if you already had minimum essential coverage for at least one of the 60 days prior to the move. In other words, you can’t go uninsured and then get coverage by moving to a new area when you’re in need of healthcare (there are exceptions for people newly released from incarceration, moving out of the Medicaid coverage gap, or moving back to the US after living abroad).
Individual health plan renewal date outside of open enrollment. Under the ACA, new plans run on a calendar year basis, and they all renew on January. But grandmothered and grandfathered plans can have renewal dates at any time of the year. If your plan is up for renewal outside of open enrollment, you’re allowed to switch to an ACA-compliant plan instead of renewing your existing plan.
An error or problem with the enrollment process that wasn’t the enrollee’s fault (ie, it was caused by the exchange, or by an enrollment assister or the health insurance carrier). The exchange and/or carrier can re-enroll the applicant outside of open enrollment in order to fix the problem.
There are other qualifying events, but these are the main ones.
Give us a call at 1-888-734-2789 for any questions, any time. We know this is confusing, and we’re here to help.
There’s Also The Short Gap Exemption: Here’s What You Need To Know
Anyone with a gap in health coverage of no more than 2 consecutive months can claim this exemption.
If anyone else on your tax return qualifies, you can claim this exemption for them too when you file your taxes.
Example: You didn’t have coverage from March 2 to June 15. Your coverage gap was 2 months – April and May. You qualify for the exemption.
If your gap was 3 months or more, you can’t claim this exemption for any of those months.
Example: You didn’t have coverage any day in April, May, or June. You can’t claim this exemption for any of those months.
If your coverage gap crosses calendar years, the months without coverage of the second tax year aren’t counted for the exemption for the first tax year. But the uncovered months from the first year are counted for the exemption for the second tax year.
Example: You didn’t have qualifying coverage November 2016, December 2016, and January 2017. You’re eligible for the short gap exemption for 2016. But for the 2017 tax year, you’re not eligible for the short gap exemption for January 2017 because you didn’t have coverage for three consecutive months – from November 2016 through January 2017.
If you had 2 or more gaps in coverage during the year you can claim this exemption only for the months of your first coverage gap. This is true even if both gaps are less than 3 months.
Example: You didn’t have coverage any day in May or any day in November or December. You can claim this exemption only for May.
Do this first
Check your records to make sure you were uncovered for only 1 or 2 months. Do the same for anyone else on your tax return you want to claim this exemption for.