Q. I will be retiring from my job in March 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.
Special enrollment period
Loss of existing minimum essential coverage and moving to an area where new QHPs are available (assuming you already had minimum essential coverage prior to the move) 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), you’ll have to wait until the next general open enrollment period, which begins each year on November 1.
Read more about the special enrollment period triggered by the loss of other coverage, and the special enrollment period triggered by a permanent move.
Maintaining continuous coverage when you move
If your move happens mid-month, you should be able to continue to use the coverage you had in your prior location until the end of the month (likely only for emergency care, assuming you’re no longer in the old plan’s provider network coverage area), and then transition to your new plan at the start of the following month.
As of 2022, HealthCare.gov (which is the exchange in the majority of the states) will no longer have a 15th-of-the-month deadline to have coverage effective the first of the following month. Instead, people enrolling during a special enrollment period will be able to get coverage the first of the following month, even if they enroll on the last day of the month.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.