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You May Still Be Able to Enroll in Health Insurance Coverage With a Qualifying Life Event

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By: Suzanne M. Fletcher, Program Lead for Health Care Reform, VP of Finance and Admin Services
May 15, 2014

This column is part of a continuing educational series about Health Care Reform from Blue Cross of Northeastern Pennsylvania.

Open enrollment for health insurance coverage in 2014 through the Affordable Care Act (ACA) recently ended.  The next time consumers can apply for coverage through an open enrollment period will be in November, for coverage that will be effective on January 1, 2015.

There are, however, special circumstances, or “qualifying life events,” that will allow some consumers to enroll in health insurance coverage outside of the open enrollment periods. 

You can start shopping for a new ACA plan 60 days before the date of a qualifying life event, such as getting married, having a child or turning 26.  Your special enrollment period starts on the date of the event and ends 60 days later. 

The federal premium tax credits and cost-share subsidies that are available during open enrollment periods will also be available for qualified consumers during these special enrollment periods.  But if you don’t enroll within those 60 days, you’ll need to wait until the next open enrollment period in November.

Let’s take a closer look at some common qualifying life events under the ACA, and what consumers need to do to make sure they are enrolled in coverage.

Common qualifying events

One of the earliest provisions enacted under the ACA allowed dependents to remain on their parent’s health insurance plan up to the age of 26.  But when you turn 26, depending on the terms of your policy, you may “age off” your parent’s plan and be required to find your own coverage.  If your 26th birthday will occur before the next open enrollment period in November, be sure to check with your parent’s insurer about the terms of their plan. 

If you don’t have the option of health insurance through your own employer, you may need to buy your own insurance during a special enrollment period to avoid a gap in coverage.  Since this will likely be the first time you’ll have your own insurance, it’s a good idea to visit the Federally Facilitated Marketplace (FFM) – also referred to as “the public exchange” – at www.healthcare.gov before your birthday. 

After setting up an account, you can find important information there before you actually purchase coverage … information about the coverage options that are available, what the cost will be and whether or not you qualify for tax credits or subsidies to help cover your costs. 

Another common qualifying life event is marriage.  If you’re getting married before the next open enrollment period in November, and your future spouse doesn’t have health insurance coverage, you can add them to the coverage you purchased through the FFM up to 60 days after your wedding date.  The time before and after a wedding can be hectic, so again, it’s a good idea to start shopping at www.healthcare.gov as soon as possible to see what coverage options are available and what you and your future spouse can fit into your budget.

Similarly, you can add a new baby, an adopted child or a foster child as a dependent to your coverage up to 60 days from the date the child joined your family.

Not all qualifying life events may be happy occasions.  For example, if you lose your job or have a death in the family and your health insurance coverage is affected, you can enroll in new coverage on the FFM within 60 days. 

Some of the events mentioned above may necessitate a move to a new state, or to a new location where different insurers are offering coverage.  In Pennsylvania, for example, the insurers offering coverage in the western part of the state differ from those offering coverage in the eastern part of the state. 

Making this type of move is considered a qualifying life event under the ACA, and you can enroll in new coverage on the FFM – or on a state exchange if the state you are moving to offers one – up to 60 days following the date of your move.

Additional special enrollment periods

If you are currently enrolled in a plan that started before January 1, 2014 and you lose qualifying coverage sometime this year, you will have a special enrollment period to sign up for new coverage.  This special enrollment period generally runs from 60 days before your plan ends to 60 days after your plan ends.

To make sure that you don’t have a gap in coverage, you must enroll in a new plan by the fifteenth day of the last month of your current plan’s coverage.  For example, if your current coverage ends on June 30, you must enroll by June 15 when enrolling on the FFM for your new coverage to begin on July 1.

It’s important to remember that if you don’t enroll in coverage during the special enrollment period for a qualifying life event like the ones mentioned above, you won’t be covered for the rest of the year.  The ACA requires that most people have health insurance, and if you’re not covered, you may have to pay a penalty.

There are so many good reasons to have health insurance, such as having peace of mind if you get sick or have an accident, accessing the preventive services and screenings that are covered, and possibly getting help paying for your coverage and out-of-pocket expenses.  We’ll discuss why it’s important for everyone to have health insurance in more detail in our next column.

In the meantime, you can always find more information about qualifying life events, special enrollment periods, tax credits and subsidies on Blue Cross of Northeastern Pennsylvania’s website at https://store.bcnepa.com/learn.