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

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 will begin 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 will be December 15, 2016 (Massachusetts, Rhode Island, and Washington state all allow enrollments to be completed as late as December 23 and still have coverage effective January 1).

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.

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 will be requiring proof of eligibility for the most common qualifying events. 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.

If you don’t experience a qualifying event in 2016, your next opportunity to enroll will be November 1, 2016, when open enrollment begins. Coverage selected at that point will be effective as of January 1, 2017.