Can I enroll in an individual health plan after Open Enrollment?

March 31, 2014

Open Enrollment for the Affordable Care Act (ACA) ends on March 31, 2014. Effective April 1, 2014 – November 14, 2014, individuals must experience a Qualifying Life Event (QLE) to be eligible to enroll for coverage during a Special Enrollment Period (SEP).

 

Individuals who experience a QLE and are currently enrolled through the Marketplace, or wish to enroll as a new applicant, must go directly to the Marketplace. The Direct Enrollment connection between insurance companies and Healthcare.gov will be turned off and messaging will be posted to the website directing users to the Federal or state Marketplace.

 

All changes that impact eligibility and circumstances must be made directly with the Marketplace to determine the impact on any financial assistance with Advance Premium Tax Credits and/or cost sharing reductions.

 

If you do not qualify for a subsidy, the enrollment process for Off Marketplace plans during SEP will be similar to enrollment during Open Enrollment except you'll be asked for the reason you're enrolling outside of Open Enrollment and the date of that event.

 

 

How long do I have to enroll after my event?

 

In most situations, the SEP window is 60 days from the date of the event. See the chart for more information.

 

To be eligible for coverage, the individual must enroll during the SEP window.

 

Individuals, who don’t have a QLE, will not be able to purchase coverage until the next Open Enrollment period begins on November 15, 2014. 

 

 

What does not count as a Qualifying Life Event?

 

For a complete list and more information about QLEs and SEPs for On Marketplace enrollments, please visit www.healthcare.gov.

 

An SEP is not available in the following circumstances:

 

  • Voluntarily quitting other health coverage or being terminated for not paying premiums

  • Losing coverage that is not considered minimum essential coverage.

  • In addition to the above items, Life Events specific to individuals already enrolled in Marketplace coverage: A change in income or household status that affects eligibility for tax credits or cost-sharing reductions

 

 

Exceptional circumstances as defined by the Marketplace:

 

Nevada Exception: The State of Nevada requires carriers to offer open enrollment all year round. April 1, 2014 – November 14, 2014, individuals can enroll for coverage without a QLE, and will need to select the option of “None” in the QLE list when applying for coverage. The effective date will be the 1st of the following month after a 90 day waiting period. For more information please visit the NV Marketplace.

 

Colorado and Kentucky State Marketplaces: Kentucky’s Kynect website will include an option for agents and consumers to select “Report a Change” and will see new screens to select the QLE in order to determine their SEP eligibility. For more information please visit Kynect.

 

In Colorado, all SEP transactions will need to go through Colorado’s Service Center. Consumers will be able to log in or create an account on the C4HCO website, but the website will direct them to the Service Center in order to complete any transactions. For more information please visit C4HCO.

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March 31, 2014

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