What are ACA Enrollment Periods and How do they Work?
There are several Affordable Care Act enrollment periods that you should be aware of. Let’s take a closer look at each of them.
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Introduction to ACA Enrollment Periods
The Affordable Care Act (ACA) provides health insurance coverage to millions of Americans who otherwise cannot afford it. Enrolling in a health insurance plan through the ACA can be a complicated process, especially if you are not familiar with the enrollment periods.
In this article, we will provide you with a comprehensive guide to the different Affordable Care Act Enrollment Periods and how they affect your health insurance coverage
What is the annual ACA Open Enrollment Period?
The annual Open Enrollment Period refers to a specific duration during which individuals can enroll in major medical health insurance plans or ACA-compliant health insurance plans. This period enables you to make adjustments to your current plan or terminate it. The Open Enrollment Period is generally consistent across all US states, although some states may choose to begin their enrollment periods earlier. These states typically operate their own marketplaces instead of being part of the federal marketplace.
When is the annual ACA Open Enrollment Period?
The federal Open Enrollment Period for health insurance coverage beginning the following year will run from November 1. In order to obtain coverage that commences from January 1, you are required to enroll before December 15.
How long is the Open Enrollment Period?
The federal Open Enrollment Period lasts for 45 days. It differs in duration from states that have their own permanent extended Open Enrollment Period.
What circumstances allow enrollment outside of Open Enrollment?
With the exception of qualifying life events, enrolling in a health insurance plan can only be done during the Open Enrollment Period. Nevertheless, if you are experiencing major life changes, such as divorce or loss of health care coverage, you may be eligible for a Special Enrollment Period. This allows you to enroll in a health plan 60 days before or after the qualifying event.
It’s important to note that failing to pay insurance premiums disqualifies you from a Special Enrollment Period.
How to qualify for Health Insurance Special Enrollment Period?
If you or anyone in your household in the past 60 days have these types of qualifying life event:
Loss of health insurance coverage
If you lose your current coverage that meets government standards.
Changes in household size
If you got married, had a baby, got divorced or lost a family member.
Changes in residence
If you moved to a new home.
Changes in citizenship
If you become a US Citizen or national.
More qualifying changes
- Changes that make you no longer eligible for Oregon Health Plan (Medicaid) or the Children’s Health Insurance Program (CHIP)
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
- Leaving incarceration
- AmeriCorps VISTA members starting or ending their service
Open Enrollment for different types of health insurance
Each type of health insurance has its own Open Enrollment dates. The Open Enrollment for the Affordable Care Act (ACA) begins on November 1 and ends on January 15. However, the specific dates may vary every year and also differ between states.
Medicare
Medicare provides an Open Enrollment Period that starts three months prior to your 65th birthday and lasts for seven months. This period is for Medicare plans Part A and B, but each part has a different Open Enrollment Period. You can enroll in Part A anytime after turning 65, and there is a Special Enrollment Period available between January 1 and March 31 for parts A and B if you fail to sign up initially. Additionally, there is an annual fall Open Enrollment Period for other parts of Medicare, which takes place from October 15 to December 7 every year. During this time, you can join Medicare Part D or switch from Medicare Advantage to Original Medicare.
Affordable Care Act
The Open Enrollment Period for the Affordable Care Act commences on November 1, 2022, and ends on January 15, 2023, although the specific dates vary each year. Additionally, some states have their own Open Enrollment Period.
- If you miss the enrollment window, you cannot obtain health insurance through an exchange unless you have a qualifying life event, such as
- the loss of existing health insurance coverage,
- a change in household status,
- a change in residence to a different ZIP code or county,
- a change in income that affects your coverage eligibility,
- release from incarceration,
- beginning or finishing service as an AmeriCorps member, or
- becoming a member of a federally recognized tribe.
Group Insurance
There is no Open Enrollment Period for health insurance obtained through an employer, but you can enroll at any time during the year, and coverage usually begins the month after enrollment.
Why do we have an open enrollment period?
The purpose of the annual Open Enrollment Period is to discourage adverse selection. This phenomenon occurs when only sick individuals enroll in health insurance plans while healthy individuals opt-out. This practice can severely impact the financial risk taken by health plans when insuring customers. Additionally, the Open Enrollment Period safeguards individuals from the risk of not having health insurance when they require unexpected, costly medical care or have a pre-existing chronic condition.
In the past, the Affordable Care Act mandated health insurance coverage under the individual mandate provision. If individuals did not have minimum essential coverage, they were subject to a tax penalty, unless they had an exemption. Although the individual mandate is no longer applicable at the federal level, some states still require health insurance. During the Open Enrollment Period, individuals cannot be rejected for ACA-compliant health insurance based on their health status. It is essential to utilize the annual Open Enrollment Period to select a healthcare plan that meets your requirements.
FAQS:
Who can enroll in health insurance during the ACA Enrollment Period?
Individuals who are not currently enrolled in health insurance can sign up for coverage during the ACA Enrollment Period. Those who already have health insurance through the ACA marketplace can also use this time to renew or change their coverage.
What happens if I miss the ACA Enrollment Period?
If you miss the ACA Enrollment Period, you may still be able to sign up for health insurance through a special enrollment period if you experience a qualifying life event, such as losing your job or getting married. Otherwise, you may have to wait until the next ACA Enrollment Period to sign up for coverage.
Can I make changes outside the Open Enrollment period?
No, changes cannot be made outside the Open Enrollment period and enrollment is only allowed during a qualifying life event. In case you require a health insurance policy outside of the Open Enrollment period, you may opt for a short-term health insurance policy. Such a policy can provide coverage for your health insurance needs for a duration of up to 364 days in most instances.
Need Help with Medicare Enrollment?
Enrolling in Medicare during a valid enrollment period is crucial to avoiding penalties, ensuring coverage, and avoiding denial of coverage in the future. To make the process easier, we have a team of licensed Medicare experts ready to assist you throughout the enrollment process.
To compare plans in your area during your eligible Medicare enrollment period, simply fill out our online form now or call Health Plans in Oregon at 503-928-6918. Our assistance is at no cost to you.
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