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I will be retiring from my job in August and moving to a new state. Do I have to establish residency there before I can apply for ACA coverage?

Q. I will be retiring from my job in August and moving to a new state. Do I have to establish residency there before I can apply for ACA coverage?

A. In general, yes. In most cases, you need to be living in a state in order to apply for insurance in that state (although it’s possible to obtain coverage even if you don’t have a fixed address in your new location). HHS had intended to allow the special enrollment period associated with a permanent move to begin 60 days before the move—that provision had been slated to take effect in January 2017, but in guidance issued in May 2016, HHS made this optional for exchanges, indefinitely.

Once you move to your new home, you’ll be able to apply for coverage. But you should contact the Division of Insurance or the exchange in your new state to see if there are any state-specific provisions that would allow you to enroll in advance of your move.

Qualifying events & special enrollment periods

Loss of existing minimum essential coverage and moving to an area where new QHPs are available are both qualifying events that trigger a special open enrollment window. You’ll have 60 days to enroll in a new plan, and the soonest your new policy could be effective is the first of the following month. This is covered in the code of federal regulations 155.420(d)(7). If you don’t enroll within 60 days of moving (or losing access to your current coverage—discussed below), you’ll have to wait until the next general open enrollment.

Loss of coverage

If you currently have employer-sponsored coverage and you’ll lose access to it when you retire, your qualifying event would be loss of other coverage (assuming that your plan qualifies as minimum essential coverage).

Rules regarding effective dates specify that in the case of loss of other minimum essential coverage, the new coverage is effective the first of the month following enrollment, if the application is submitted prior to the loss of coverage (so for example, if you’re retiring on August 15, moving on August 20, and your coverage will end on August 31, you could enroll on August 25 and still have coverage effective September 1).

But if you enroll after your coverage ends, normal effective date rules are followed, which means that in most states, you’ll need to enroll by the 15th of the month in order to have coverage effective the first of the following month.

A permanent move to an area with different QHPs

If you currently have a plan that you purchased in the individual market, it’s possible that your existing plan could still provide coverage in your new location, depending on the network. In that case, your special enrollment period would be triggered simply by a permanent move to an area where different QHPs are available.

It’s important to note that as of July 11, 2016, a move to a new area only triggers a special enrollment period for people who were already insured prior to the move (defined as having minimum essential coverage for at least one of the 60 days prior to the move).

If your qualifying event is a permanent move, effective dates would follow the same rules as general open enrollment: If you enroll in a new plan by the 15th of the month, your new coverage would be effective the first of the following month. If you enroll after the 15th of the month, your new policy would be effective the first of the second following month.

In that case, you’ll likely have a short gap in coverage while you wait for your new policy to become effective. If so, you may want to consider a short-term plan to provide coverage during that time.

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