Before 2014, you could buy a healthcare plan whenever you wanted. This is no longer the case. Today (2017) there is a set health insurance open enrollment period that runs for several months at the end of the year. In 2016 the open enrollment period for 2017 coverage will run from November 1st, 2016 until January 31st, 2017. Individuals and families that buy their own health insurance plan only have that window of time to buy healthcare coverage or shop for a different health insurance plan.
If you do not buy health insurance during the open enrollment period, you are not necessarily out of luck. There are certain life events that trigger a special open enrollment period, allowing individuals to enroll in a healthcare plan outside of the normal enrollment period. These circumstances are known as “qualifying life events”.
What are qualifying life events? Tyler and Ana will help explain.
Tyler and Ana are getting married on June 20th. Tyler is 28 years old and Ana is 27, going on 28 later that year. Tyler is an entrepreneur, and working with a college friend on a new technology start-up idea. He doesn’t have any health insurance. Ana is a freelance graphic designer and has a Catastrophic health insurance plan, which is a low cost, high deductible health insurance plan, available to millennials under the age of 30.
Can Tyler get health insurance outside of the open enrollment period? Yes. Tyler can buy health insurance after June 20th and before August 20th. Even though Ana already has a healthcare plan, she can upgrade her health insurance plan to something different, or cancel her current health coverage and get a new family plan with Tyler. Why? Getting married is considered a qualifying life event and they are eligible for the special open enrollment period.
Tyler and Ana get married, and the wedding is beautiful. For their health insurance needs, Ana decides to keep her Catastrophic healthcare plan, and Tyler opts for a Silver plan because even with their combined incomes, Tyler qualifies for a tax subsidy that greatly reduces the price of his health insurance premium.
Several years later, Ana changes her health insurance plan to a Bronze plan because she is no longer eligible to have a Catastrophic plan since she is now 30 years old. She is able to do this during the special open enrollment period since her 30th birthday is in August.
A few more years go by, and Tyler and Ana become pregnant, and give birth to a bouncing baby boy. Concerned about their medical costs now that they are a family, Tyler and Ana once again update their health insurance to a Gold family plan within 60 days after their son’s birth. Tyler’s start-up has gotten millions of venture capital funding over the years, and has taken off, so they can afford a healthcare plan that is more expensive on a monthly basis, but pays more of the incoming medical bills.
Five years later, Tyler and Ana’s family has continued to grow – so much so that they need a bigger house! Tyler has sold his first business and is looking for new opportunities in the technology world, so they decide to relocate to San Francisco. Now that they have updated their health insurance several times over the years, Tyler and Ana know the ins- and outs of buying Obamacare plans. They know that moving to a new ZIP code qualifies them for the special open enrollment period.
Within a few months of the move, Ana decides to go to work for a marketing agency for a change of pace. Now that she is a full-time employee of a company, she is able to move the family on to her employer health insurance coverage. However, within two years Ana realizes the corporate world is not for her, so she quits her job and goes back to freelancing, now that she’s made new connections in the San Francisco area. Once again, the family is eligible for the special open enrollment period, and they go back on an Obamacare plan similar to what they had the last time they were required to buy health insurance on their own.
As Tyler and Ana’s life has explained, there are many instances when “life happens” and individuals are able to enroll in a healthcare plan outside of the regular open enrollment period.
It’s important to note that not everyone is required to buy a health insurance plan. There are exemptions to the rule. However, the majority of Americans who purchase their own health insurance are required to have coverage, or could suffer from a tax penalty for not carrying coverage.