Open enrollment under the Affordable Care Act (known informally as “Obamacare”) is a window of time during which enrollees can select the coverage options that best meet their needs. For some, the thought of missing open enrollment of Obamacare strikes fear and anxiety, as thoughts of an uninsured catastrophic medical event take hold.

However, if this is you, take heart – there may be options out there to cover your health needs until the next open enrollment period takes effect. Also, unique circumstances may also allow for a special enrollment period – so long as certain criteria are met.

Basics of Obamacare Open Enrollment

As the name suggests, Obamacare open enrollment refers to the time when the option to sign up for coverage is open for all. During this period, those who are uninsured may select coverage, as well as those who are insured elsewhere and looking for a change. Many working Americans select their Obamacare coverage plans through their employer and are generally required to contribute to the costs of the premium. For these folks, open enrollment periods may vary depending on the employer’s methods of enrollment eligible workers.

The most recent open enrollment period occurred Thursday, November 1, 2018, and ran through Saturday, December 15, 2018. During that period, an estimated 8.4 million Americans selected an Obamacare plan – or were re-enrolled in their previous plan. Overall, since the inception of Obamacare, an estimated 59 million policies have been purchased to cover healthcare ranging from basic preventative wellness to treatment for major illness and injury.

Generally, if you missed the open enrollment window, you are not eligible to apply until the next round scheduled for November 1, 2019, to December 15, 2019. However, if you fit into any of the special categories below, full coverage may be just a click away.

Qualifying for a Special Enrollment Period

If you missed open enrollment for an Obamacare program, a Special Enrollment Period available to ensure you and your family are covered for the remainder of 2019 until open enrollment occurs again. Any of the following situations could qualify:

1. Loss of Coverage

Obamacare special enrollment is an option for anyone who lost health coverage in the last 60 days (or anticipates losing coverage within the next 60 days.) Acceptable reasons for loss of coverage include:

  • Loss of employment: Job loss due to resignation, downsizing or being fired are all qualifiers
  • Family changes: This includes divorce or any other major family change resulting in a sudden loss of health insurance.
  • Eligibility changes: Loss of coverage also includes losing eligibility for Medicaid, running out of COBRA coverage, turning 26 and losing coverage under a parent, or a self-purchased plan runs out.

2. Changes to the Family

Many major life events qualify as a “loss of coverage” to allow for special enrollment. This includes getting married, having a baby (or otherwise gaining a dependent), getting divorced or the death of a primary policyholder. An important distinction for divorcees, however, is that the divorce must lead to the actual loss of coverage under the former spouse (divorce alone does not qualify).

3. Changes to Income

Obamacare eligibility takes into account one’s income and cost of living. Major changes in these areas could trigger eligibility for special enrollment, including job loss or significant reduction of wages. Also, if a move results in a drastic change in the cost of living (determined by zip code), you are a student that graduates and moves (or is just starting school), or you recently moved to the U.S. from a foreign nation.

4. New Status

Lastly, a change in personal status can mean special enrollment privileges. It includes release from incarceration, gaining citizenship or lawful presence in the U.S. Also, if a change in income results in loss of eligibility for Medicaid (or you are denied), special enrollment may be an option.  

CHIP & Medicaid

Two programs offering medical coverage year-round include Medicaid and the Children’s Health Insurance Program (known as “CHIP”). If you missed the Obamacare open enrollment period and meet certain income criteria, one or both of these programs may be an option for you and your family. Medicaid and CHIP are income-based and exist to serve applicants in lower income brackets (based on family size). Applications are available online, and programs are administered locally through state-level benefits offices.

Preparing for 2020

The Obamacare open enrollment period for 2020 is scheduled for November 1, 2019, through December 15, 2019 – so mark your calendar now! Your state may also offer a specific extended deadline, but this varies greatly and you should not rely on the possibility of an extension when planning for coverage. To get started, the healthcare.gov website provides a great deal of information for applicants and allows shoppers the opportunity to preview marketplace plans before enrolling. All plans purchased during the 2020 open enrollment period will begin coverage on January 1, 2020.   

Open Enrollment in the News

In December 2018, Obamacare made the news after a Texas federal judge ruled that the Affordable Care Act was unconstitutional. The case, aptly named Texas v. United States, came about when 26 attorneys general across the nation filed a joint lawsuit arguing that it is against the Constitution for the government to require people to purchase health insurance or face a financial penalty. The federal judge agreed.

The case is on appeal in the Fifth Circuit Court of Appeals and may eventually make its way to the Supreme Court. For now, however, Obamacare open enrollment is slated to continue as scheduled, and current enrollees are not impacted by this ruling.

At Fiorella Insurance, we work closely with individuals and families to select an affordable and manageable healthcare plan. To learn more, call today: (772) 283-0003.

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