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What are the ACA’s enrollment periods and when can I enroll outside of the open enrollment period?

  • By
  • healthinsurance.org contributor
  • August 31, 2015

Q: What are the Affordable Care Act enrollment periods and when can I enroll outside of the open enrollment period?

A: For 2016 coverage, enrollment in individual health insurance plans (on- or off-exchange) runs from November 1, 2015 until January 31, 2016.  For coverage to be effective January 1, 2016, enrollment must be completed by December 15, 2015 in all but four states. (Applicants in Maryland, Massachusetts, Rhode Island, and Washington have a few extra days).

The dates for the upcoming open enrollment period are different from 2015 and 2014 – and they will likely be different again for 2017; the November 1 to January 31 open enrollment period only applies for 2016 coverage.

The individual mandate has been in place since January 1, 2014, so most Americans are now used to the idea that they must maintain health insurance coverage in order to avoid a tax penalty.  But the penalty is increasing in 2015 and 2016.

If you didn’t have coverage in 2015, the penalty is $325 per uninsured adult (half that amount for a child), up to $975 per family, OR 2 percent of household income above the tax filing threshold.  If you don’t have coverage in 2016, the penalty will be $695 per uninsured adult ($2,085 per family), OR 2.5 percent of household income above the tax filing threshold. (You can use our calculator to determine how much your penalty would be.)

So if you’re still uninsured, the penalty could be particularly steep in 2016 – and the window to obtain coverage for the year ends on January 31.

Regardless of whether you purchase insurance through the exchange or off-exchange, the open enrollment window applies. (Nevada is an exception – coverage is available there outside the exchange year-round; and in Arizona, the CO-OP offers year-round enrollment outside the exchange.)  But in the rest of the country, you cannot enroll outside of open enrollment unless you have a qualifying event, such as:

Native Americans and Alaska Natives can enroll year-round.  Applicants who are eligible for Medicaid can also enroll year-round.