ACA Characteristics

It’s hard to believe that Healthcare Marketplace went online three years ago, and harder still to believe that a third open enrollment period has come and gone. Open enrollment for health insurance under the Affordable Care Act in 2015 will end on Tuesday, December 15. Coverage for those who have signed up will begin on January 1, 2016.

As a reminder, if you do not have health insurance as provided by the ACA, Medicare, or another provider, you will be subject to the ACA’s tax penalty (also known as the individual mandate).

That said, there is a fallback for people who, for whatever reason, have missed the deadline. Read on to find out if you qualify for a special enrollment period.

Qualifying for Special Enrollment Due to Life Changes

If you were unable to sign up for a health insurance plan under open enrollment, you might be eligible for a special enrollment period. A special enrollment period is a 60-day window following a significant life change. The list of life changes are as follows:

  • Involuntary loss of health coverage: If you had a health coverage plan but lose it, either because you lose your job or for other reasons beyond your control, you might qualify for special enrollment.
  • Marriage: If you get married and you or your spouse need to update your health insurance plan, you might be qualified.
  • Having a child: If you or your spouse gives birth to a child, or if you adopt a child, you get 60 days to add them to your health plan.

There are timing factors that apply to all of these, so if you think a life change like those listed above qualifies you for special enrollment, get in touch with us, and we will be able to help you out.

Qualifying for Special Enrollment due to Extraordinary Circumstances

If you missed open enrollment, but none of the listed life changes above apply to you, you could still be eligible for a special enrollment period. If you are prevented from enrolling due to one of the following situations, you might qualify:

  • Sudden hospitalization or temporary cognitive disability
  • Natural disaster
  • Misinformation or misrepresentation by an advisor not affiliated with a marketplace or
  • Enrollment error
    • Error resulting from an insurance company being unable to communicate with the marketplace
    • Errors related to your immigration status
    • Display errors on
    • Medicaid/Marketplace transfer error
  • Unresolved casework
  • Domestic abuse/violence or spousal abandonment
  • Other technical or system errors related to, Medicare, or Medicaid services

This list is fairly extensive with the goal of covering as many situations as possible. The goal of the Affordable Care Act is to provide as many people with health insurance as possible.

If you are still unsure whether you are eligible for special enrollment, please contact us at Osborne Insurance Services. Our advisors will work with you to further explain any of the circumstances listed above or to determine another path to essential healthcare.


Tags: Obamacare