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If I enroll in the exchange, will that coverage take effect immediately?

Q: If I enroll in the exchanges, will that coverage take effect immediately? What’s the earliest my coverage will take effect after I complete the enrollment process?

A: No, it will not take effect immediately. Your coverage effective date mostly depends on the date that you enroll, although there are some qualifying events that allow for effective dates that differ from the regular schedule.

But the regular schedule in all but two states works like this:

  • If you enroll by the 15th of the month, your coverage will take effect the first of the following month.
  • If you enroll between the 16th and the end of the month, your coverage will take effect the first of the second following month.

So an enrollment completed on May 9 would have a June 1 effective date, but an enrollment completed on May 17 would have a July 1 effective date.

Two states with different rules

There are two states — Massachusetts and Rhode Island — where the exchanges allow people to enroll as late as the 23rd of the month and still have a first of the following month effective date. So May 17 enrollment in one of those three states would result in a June 1 effective date (but a May 24 enrollment would result in a July 1 effective date).  Washington used to have a 23rd of the month deadline aswell, but they changed that in 2017, and now use the same 15th of the month enrollment deadline that’s used in most other states.

Qualifying events with different effective date rules

If you’re enrolling during a special enrollment period triggered by a qualifying event, effective dates mostly still follow the same schedule outlined above. But if you get married, you’re eligible to get coverage effective the first of the following month, regardless of how late in the month you enroll. And if you have a baby, adopt a child, or receive a court order for medical child support, the coverage can be backdated to the date of the birth, adoption, or court order. Loss of other coverage is a qualifying event that also allows for different effective date rules — if you enroll before your old plan ends, you can enroll up until the last day of the month and your new plan will take effect the first of the following month.

2018 open enrollment

Open enrollment for 2018 coverage began on November 1, 2017, and the first available effective date (even for people who signed up on November 1, 2017) is January 1, 2018. This will be the effective date for nearly everyone who signs up during open enrollment, and in most states, open enrollment ends on December 15, 2017.

There are nine states where open enrollment for 2018 coverage will continue past December 15, 2017. In most of those states, enrollments must still be submitted by December 15 in order to have coverage effective January 1 (enrollments submitted during the extended open enrollment — after December 15 — will end up with effective dates in February or March). But there are three state-run exchanges that are allowing people to enroll after December 15, 2017 and still have coverage effective January 1, 2018:

  • Connecticut: residents can enroll until December 22, 2017 for coverage effective January 1, 2018.
  • Massachusetts: residents can enroll until December 23, 2017 for coverage effective January 1, 2018.
  • Rhode Island: residents can enroll until December 31, 2017 for coverage effective January 1, 2018.

Outside the exchanges, effective dates generally follow the same rules as inside the exchanges. When exchanges offer extensions, carriers can opt to allow the same extension outside the exchange, but they’re not required to do so.