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

  • By
  • healthinsurance.org contributor
  • January 2, 2017

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

A: Open enrollment for 2017 began on November 1, 2016, and will end on January 31, 2017. These dates are for both on and off-exchange plans. In most states, the deadline to enroll in a plan with a January 1, 2017 effective date was December 19, 2016 (Massachusetts, Rhode Island, and Washington state all allowed enrollments to be completed as late as December 23 and still have coverage effective January 1; the December 19 deadline in most other states was an extension, as the normal deadline would have been December 15).

In the Benefit and Payment Parameters for 2017, HHS confirmed that they will maintain this same November 1 to January 31 open enrollment period for 2018 coverage as well (ie, open enrollment for 2018 coverage will begin on November 1, 2017 and will end on January 31, 2018).

But after that, for coverage effective in 2019 and beyond, open enrollment will be shorter, and will end before the start of the coverage year. It will run from November 1 to December 15, with coverage effective January 1.

Open enrollment schedule under the Trump Administration

The future of the ACA — including scheduled enrollment periods — is very much up in the air under the Trump Administration (you can see more in our Repeal & Replace section). Republican proposals for replacing the ACA don’t necessarily rely on open enrollment periods. Some call for guaranteed-issue coverage only for people who maintain continuous coverage, and medical underwriting (or high-risk pool coverage) for those who don’t.

But Congressional leaders have said the implementation of their ACA repeal is likely to be delayed by two to four years, meaning that open enrollment will likely continue as scheduled for 2018, and possibly beyond.

Special enrollment periods

Regardless of whether you purchase insurance through the exchange or off-exchange, the annual open enrollment window applies. Nevada is an exception – coverage is available there outside the exchange year-round, albeit without subsidies and with a 90 day waiting period before coverage becomes effective. But in the rest of the country, you cannot enroll outside of open enrollment unless you have a qualifying event, such as:

Starting in 2016, Healthcare.gov began requiring proof of eligibility for the most common qualifying events, and they’re stepping up their eligibility verification process in 2017. Some state-based exchanges were already requiring proof, and health insurance carriers also generally require proof of eligibility when people enroll off-exchange during a special enrollment period. If you experience a qualifying event and wish to enroll in a plan during your special enrollment period, be prepared to provide documentation of the qualifying event.

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

Open enrollment for 2017 ends on January 31, 2017. After that, if you don’t experience a qualifying event in 2017, your next opportunity to enroll will be November 1, 2017, when open enrollment begins again. Coverage selected at that point will be effective as of January 1, 2018.