Securing Coverage Outside of Open Enrollment

Multiple changes were introduced with the Affordable Care Act (ACA) and a topic of much discussion has been exactly when individuals can purchase a new health plan and what qualifying events are required to guarantee approval for coverage.

As it has been widely reported, the first annual Open Enrollment Period ended on March 31. What are your options if you missed this deadline?  We’ve put together a list of common eligibility requirements below.

How do you qualify for a Special Enrollment?

While the first enrollment period has closed, the next one begins November 15.  Until that time, there are specific life events that allow individuals and families to sign up for a new health coverage plan. If one of the following events has occurred recently, you may qualify for a special 60-day period in which you can shop for health coverage options on the individual market.

Loss of Employer Sponsored Coverage If you were recently terminated, resigned, or received a reduction in hours, or exhausted COBRA, you may qualify for a Special Enrollment with supporting proof of the loss of coverage.

Current Private Coverage Transitioned to a New ACA policy If your previous individual health policy was transitioned to a new ACA policy that does not fit your needs, there are options available to change benefits and/or carriers within 30 days of your transition.

No Longer a Dependent If you have reached the maximum dependent age (as a child dependent), or are no longer a dependent due to death or divorce.

Marriage or Divorce If you were recently married or divorced, you must provide proof through a marriage certificate or divorce decree stating the date of the event.

Birth or Adoption If you recently gained a dependent child through birth or adoption, your family and the child will qualify for a special enrollment period.

Permanent Residence Change If you moved to a new state and/or coverage area, you qualify to purchase a new health plan. Supporting documentation includes a new utility bill or rental/lease agreement.

Court Ordered In some cases, court orders are issued to provide health coverage for specific members of a family. In this case, proof can be provided through the legal documentation stating the order.

Please note, there are many other life events in which an individual or family could potentially qualify for a Special Enrollment Period for major medical coverage.

What if you don’t qualify for a Special Enrollment Period?

If you do not qualify for enrollment in a major medical health plan, there are a few other options to fill the gap between enrollment periods. Though these options are not compliant with the Affordable Care Act, they provide protection and coverage so you are not left vulnerable.

Short-Term Health Coverage With options anywhere from one month to six continuous months of coverage, short-term health plans are a low cost option for catastrophic coverage. Please note that short-term plans do not provide full coverage benefits like a major medical policy.

Indemnity Plans Fixed benefit plans pay cash to help with everyday medical expenses. Though this is not insurance, it helps with the cost for office visits, diagnostics, and even some prescriptions.

Do you need help in determining your eligibility for coverage? Please contact a Caravus Individual Market consultant:

Katie Haug  |  |  314.259.5009 Ashley Heese  |  |  314.259.5025