eHealth Answers Questions for Consumers Who Missed the Affordable Care Act's Open Enrollment Deadline
The Affordable Care Act (ACA) created a first-ever nationwide open enrollment period for individuals and families purchasing coverage on their own which began on
"Unfortunately, there are still Americans without health insurance today," said
Frequently Asked Questions for Consumers Who Missed Open Enrollment
QUESTION: I just heard about this deadline. What was it? What did I miss?
ANSWER: The Affordable Care Act (the health care reform law also known as "Obamacare") created a nationwide open enrollment period for people to purchase individual and family health insurance on their own. For fully-reformed, 2014 health insurance plans, open enrollment began on
Q: Is the government going to extend the open enrollment period or add a new open enrollment period mid-year in 2014?
A: The federal government has said that the Affordable Care Act's open enrollment period will not be extended. They have not indicated that any additional open enrollment opportunities will be established for 2014, though some consumers who started applications prior to the end of open enrollment will be granted more time to complete them if they were unable to finish due to certain system errors on the federal marketplace. Health insurance companies may create additional open enrollment periods for their customers, or even additional special enrollment periods for additional qualifying life events. Contact your state's
Q: Missing the
A: You may be subject to a tax penalty on your 2014 federal taxes if you did not obtain and keep minimum essential coverage without a gap of three consecutive months or more during the year (some exemptions may apply). So, if you have been uninsured since
Q: How much is the tax penalty for going uninsured in 2014? I heard it's only
A: Depending on your household size and your income, you could end up paying much more than
Q: Missing the deadline just means that I may now be declined for pre-existing conditions when I apply for coverage, right?
A: No. Insurance companies can no longer decline coverage under a major medical health insurance plan to anyone for pre-existing medical conditions, at any time of year. However, outside of an open enrollment period they are not obliged to sell health insurance to consumers who have not experienced a qualifying life event or some other exceptional circumstance (such as a system error) defined by the law.
Q: Can I still buy health insurance through a government exchange?
A: Outside of the open enrollment period, you cannot purchase individual or family health insurance through a government exchange unless you experience a qualifying life event or some other exceptional circumstance (such as a system error) defined by the law.
Q: Can I still buy health insurance outside of a government exchange, like through a licensed agent?
A: Outside of an open enrollment period, you typically cannot purchase health reform-compliant major medical individual or family health insurance plans through any source, unless you experience a qualifying life event or unless an insurance company voluntary elects to create additional enrollment periods. However, there may be other insurance products available to you which can offer some level of protection, although they will not meet your coverage requirements under the Affordable Care Act and you may still be subject to a tax penalty. You should also know that it may be possible to be declined coverage for alternate forms of coverage based on your personal medical history. Some alternate forms of coverage may include, but are not limited to, the following:
- Short-term health insurance plans. Short-term plans typically provide coverage for periods of 30 days up to twelve months at a time. They typically will not cover pre-existing conditions or preventive medical care but they can provide you with a limit to your financial liability for medical bills in case of hospitalization.
- Accident insurance. Accident insurance plans provide you with a cash payout if you suffer from specific injuries. The payout is made to you rather than to your medical provider and you can use the money for whatever you choose.
- Critical illness insurance. These plans work like accident insurance but are designed to provide you with a cash payout in case you are diagnosed with a serious illness.
- Dental or vision insurance. Dental insurance or vision insurance plans typically provide you with coverage for a specific set of services within a specific period of time.
To learn more about these kinds of insurance options, get quotes and compare your options through a licensed agent like eHealth.
Q: I've heard about "qualifying events" that allow me to purchase coverage on my own outside of open enrollment. Can you give me some examples?
A: Qualifying life events that may allow you to purchase health care reform-compliant health insurance plans outside of the open enrollment period include, but are not limited to, the following:
- Permanently moving to a new city or state.
- The birth or adoption of a child.
- Getting married.
- The loss of other minimum essential coverage due to divorce, the loss of a job or loss of eligibility for
Medicaid or other government-sponsored coverage. - Loss of coverage under a parent's health insurance plans when an adult child turns 26.
- Certain changes to your income which may alter your eligibility for government assistance when purchasing coverage.
If you experience any of these, you may trigger a "special enrollment period" allowing you to purchase coverage on your own outside of open enrollment.
Q: If I experience a qualifying event, how long will I have to purchase a health insurance plan on my own?
A: In most cases, you will have 60 days after the date that triggered a qualifying event to purchase major medical individual or family health insurance coverage.
Q: Where can I purchase health insurance if I experience a qualifying event?
A: If you experience a qualifying life event, you can compare options and enroll in coverage through a licensed online health insurance agent like eHealth or through your state's government-run health insurance exchange.
Q: Will government health insurance subsidies be available for people who have qualifying events outside of open enrollment?
A: Yes, if you meet the criteria for subsidy eligibility and also experience a qualifying event, you may be able to obtain government subsidies when purchasing coverage during your special enrollment period. In order to qualify for a subsidy, your annual household income must fall between 100% to 400% of the federal poverty level (other criteria may apply as well). 400% of the federal poverty level is about
Q: Will I need to provide proof that I've experienced a qualifying event?
A: You will probably need to provide proof. However, the answer may vary depending on the rules in your state or the policies of the individual health insurance company whose plan you select. A licensed health insurance agent like eHealth can help you understand what may be required of you by different insurers.
Q: If I have a baby, is that a qualifying event just for my baby or for the whole family?
A: Having a baby is a qualifying event for the family as a whole. This is so because adding a child to the family may change your tax situation and your eligibility for government subsidies and other forms of assistance.
Q: When is the next nationwide open enrollment period under the Affordable Care Act?
A: The next nationwide open enrollment period begins on
About eHealth
For more health insurance news and information, visit the eHealth consumer blog: Get Smart - Get Covered or visit eHealth's Affordable Care Act Resource Center at www.eHealth.com/affordable-care-act.
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