Health insurance is a virtual necessity in our world. It is almost certain that you will need a flu shot, strain your back or have a bout of food poisoning after you lose your health coverage. Just as important, you don’t want to pay a fine at tax time for having less than year-round coverage. Filling in those coverage gaps is very important, not only for the health of you and your family, but also to protect your finances.
There are many ways to maintain coverage between jobs, before open enrollment starts, or if you are waiting to turn 65. In some cases, you may be able to finesse your last employer to extend their health coverage, at least until your next job or policy starts. In other cases, you may qualify for a life change that allows you to get a health plan from the Affordable Care Act-sponsored independent health insurance marketplaces, even if it isn’t an enrollment period.
What Is Open Enrollment?
In case you aren’t aware of it, the U.S. Congress passed the Affordable Care Act in 2010 that created many important changes in the American health care system. It allowed states to use federal funds to expand Medicaid, an insurance program for poor and disabled. ACA also required that insurers issue policies to any American, even if they already had a pre-existing condition, and it made it mandatory for all policies to include free or low-cost services like annual checkups, diet counseling and vaccines.
Most importantly, the Affordable Care Act (also known as Obamacare) created regional health insurance marketplaces where Americans could purchase health plans. Additionally, many of these health plans could be very cheap—almost free, in some cases—if you qualified for the Premium Tax Credit. The primary eligibility requirement was household income between 100 and 400 percent of the poverty level. If you met the eligibility criteria, the government would subsidize your health plan, sometimes up to hundreds of dollars a month.
However, even if you are eligible for an Obamacare health plan, you may not be able to sign up immediately. Like many federal aid programs, Obamacare enrollment is only available at certain times of the year. In years past, the open enrollment period has been November 1 of the prior year up to January 31; however, the Trump administration has shortened this window starting in 2017. This year, the open enrollment period for 2018 will be from November 1, 2017 to December 15, 2017.
How to Qualify for Obamacare Special Enrollment
If you miss the open enrollment window for an Obamacare, you may still be able to sign up through a special enrollment exemption. To be eligible for a special enrollment, you must first visit www.healthcare.gov and complete the questionnaire. You may then apply for a special enrollment based on one or more of the following life events:
Loss of health insurance
- Loss of job-based, individual or student policy
- Lost eligibility for Medicare, Medicaid or Children’s Health Insurance Program
- Aged 26 and lost coverage through parent’s plan
- Married or divorced
- Had or adopted a child
- Family member died
- Moved to new ZIP code
- Student relocated residence
- Seasonal home change
- Move from or to shelter or transitional housing
Other life events
- Change in income
- New membership to indigenous peoples’ tribe
- New citizenship status
- Ended incarceration
- Starting or ending Americorps service
If you are approved for a special enrollment, you may immediately sign up for a health plan. You may find a variety of health plans from several participating insurers on the health insurance exchange. These plans come in tiers of Bronze, Silver, Gold and Platinum, with Bronze plans having the lowest cost and least benefits and Platinum plans offering the greatest coverage at a commensurate cost.
Alternatives to Obamacare
If you are not in an open enrollment period or qualify for a special enrollment, you may still be able to take advantage of some other federal programs. The Consolidated Omnibus Budget Reconciliation Act of 1985 (or COBRA) is a federal insurance program that may allow you to extend your last employer’s health plan. Under COBRA, you may qualify for up to 18 months of additional health coverage for you and your family after employment termination; 29 months of additional health coverage if you are deemed disabled; or up to 36 months of coverage for your spouse and children upon your death or a divorce.
Like special enrollment for Obamacare plans, COBRA is only available to people with qualifying life events that include:
- Employment termination
- Reduction of work hours
- Death of a covered employee
- Divorce or legal separation
- Enrollment in Medicare
- A dependent child is no longer eligible for coverage
If you are eligible for COBRA, you should note that COBRA coverage offers the same benefits and is identical to the employee health plan under your last employer, but it is likely to be more expensive because your employer is not required to subsidize your COBRA plan.
If you are aged 65 or older and your old health plan is terminated, you may sign up for Medicare. Medicare is the federal insurance program for seniors that you may enroll in through your Social Security office. You may sign up for traditional Medicare or for Medicare Advantage (which is administered by a private insurer). Traditional Medicare includes inpatient and outpatient services with the option for Medicare Part D which covers prescription drugs.
Medicare Advantage offers all of the benefits of Medicare Parts A and B, and may also include additional benefits like prescription drugs, vision or dental. If you choose a Medicare Advantage plan, you will be insured through a private insurer, but Medicare will pay for all or some of your premium.
To learn more about your options during a health coverage gap, please visit Boost Health Insurance and speak with one of our agents.