What is The Special Enrollment Period for Obamacare Health Insurance?

Category: Obamacare (Affordable Care Act) Originally Posted: April 17, 2015 by Colleen McGuire Last modified: September 12, 2016

If you read or watch any news about Obamacare plans or buying health insurance, you might hear terms like “open enrollment” and “special enrollment period”, but what do those phrases mean?

If you have health insurance through your employer, there is a set time each year when you can update your health insurance plan. You might know it as “open enrollment.” In many cases, the human resources department has working sessions with employees to discuss changes to their health insurance coverage for the following year, and make adjustments to healthcare plans, such as adding a spouse or child to the policy.

With the passing of the Patient Protection and Affordable Care Act, also referred to as Obamacare, the health insurance shopping process is much the same for individuals who buy their own health insurance. Once a year individuals and families who do not have access to health insurance through an employer can sign up for health insurance online, with an insurance broker or directly through a health insurance company. This is called the open enrollment period, and for 2017 coverage, open enrollment begins November 1, 2016 and ends January 31, 2017.

Should an individual not know about the open enrollment period and let it slip by, they could be stuck without health insurance for the next year, which is why it is very important to pay attention to the dates of when the insurance enrollment season is open. However, there are individual circumstances that do allow individuals and families to enroll in a healthcare plan outside of the enrollment period. This frame of time is known as the special open enrollment period.

Special open enrollment is offered to Americans who have a situation arise, typically referred to as a qualifying life event.

These events include:

  • Getting married
  • Getting divorced
  • Having a baby
  • Adopting a child
  • Death of individual in household, reducing household size
  • Any change of household size that will impact household tax subsidy
  • Moving to a different ZIP code
  • Losing employer health insurance coverage
  • Having COBRA coverage expire
  • Losing coverage from parent’s healthcare plan because child has turned 26 years old
  • Having a change in income and no longer qualifying for Medicaid
  • Having a change in income and need to adjust reported gross income to adjust tax subsidy
  • Being released from jail
  • Being discharged from the Armed Forces
  • An error was made when originally applying for health insurance, which resulted in no coverage

If any of these instances occur during the special open enrollment period, you can take advantage of the special circumstance and either gain new healthcare coverage or change the existing coverage you have.

For example, it is common for families to move during the summer months once school is out of session. If a family moves to another part of the state or even across town and has a change in ZIP code, they are eligible to either obtain health insurance coverage or change the plan they are in to ensure that their preferred network of doctors are available in their new coverage area.

It is important to note that there is only a 60 day window of opportunity to enroll in a healthcare plan during the special open enrollment period. This means that if a couple gets married on May 31, they must enroll in a new health insurance plan before the end of July. If a couple has a baby on August 15th, they must apply for healthcare coverage or change their existing coverage before the middle of October. Once the 60 day window has passed, individuals have to wait until the regular open enrollment period to obtain health insurance coverage or update their current coverage.

Still not sure if you qualify for a health insurance plan during the special open enrollment period? Visit HealthCare.com and learn more about qualifying life events.