Open enrollment for 2016 health coverage has ended, and that means if you didn’t choose a health insurance option and you’re not covered by your employer’s insurance plan, you’ll have to wait until 2017 to get health insurance under the government’s open enrollment guidelines – unless you meet one of the criteria for a “special enrollment” or you’re eligible for another government-supported program.
Special Enrollment Criteria
Under the Affordable Care Act, you may be eligible to enroll or alter coverage beyond the January 31 cutoff date if you:
- have a baby born after the cutoff date or adopt a child after the cutoff date and need coverage for that child
- place a child into the foster care system
- get married
- lose your health insurance as a result of losing your job
- lose certain other types of insurance, including Medicare, CHIP and Medicaid or coverage under COBRA
- move to another state
- become a U.S. citizen
- are released from jail or prison
- turn 26 and “age out” of your parent’s plan
- have a change of dependency for someone covered by your plan (either gain or loss of a dependent or change in your own status that qualifies you or disqualifies you as a dependent)
- have a change in your income that affects your coverage qualifications
- have a death of a person covered by your insurance
- become a member of a federally-recognized tribe or become an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- are determined ineligible for Medicaid or CHIP coverage
- are a victim of domestic violence or are abandoned by your spouse
- experience an exceptional circumstance such as an unexpected hospitalization or natural disaster that prevented your from enrolling
If you think you may qualify for one of these events or have a similar issue that prevented you from enrolling or affects your current enrollment, you can find out more about the special enrollment period by visiting the special enrollment page on the government website and using the enrollment qualification screener. You can also determine if you’re eligible for special enrollment by calling the Marketplace Call Center at 1-800-318-2596.
Appealing a Decision
If you feel an error was made in determining your eligibility for certain healthcare coverage or your effective coverage date is incorrect, you may also qualify for enrollment after the January 31 cutoff if you file for an appeal. You can also appeal if your request to be considered for special enrollment is denied. Details about the appeals process can also be found on the government website.
No matter what circumstances caused you to miss the deadline, if you feel you qualify for an exception, it’s important to act as quickly as possible to determine if you can still enroll during the special enrollment period. Otherwise, you can be subject to fines for lack of coverage.
Need more help? Demetree Insurance Services is here when you need us. Give us a call at 904-309-9331 today.