Chapter 2: Special Enrollment Guide

Who doesn’t need a special enrollment period?

If you’re in one of seven categories, you don’t need a qualifying event – even if you missed Obamacare’s annual open enrollment period

The Insider's Guide to Obamacare's Special EnrollmentIf you need to obtain your own health insurance (ie, not through your employer), you’re probably familiar by now with the fact that the individual health insurance market has an annual open enrollment period. To enroll outside of open enrollment, most applicants will need a qualifying event in order to trigger a special enrollment period (SEP).

But qualifying events and SEPs aren’t always necessary. Enrollment continues year-round in some cases, and you don’t need a qualifying event if you’re in one of these categories:

  • Residents of New York who are eligible for The Essential Plan. This is a Basic Health Program (BHP) that was implemented in New York in 2016. It’s available for residents who are not eligible for Medicaid or CHIP, and whose annual household income is up to 200 percent of the federal poverty level. A single individual can qualify for The Essential Plan in 2016 with an income up to $23,540, and enrollment continues year-round.
  • Residents of Nevada who purchase coverage outside the exchange. Nevada is unique in that state law requires off-exchange health plans to be available for purchase year-round. Health insurance carriers can impose a 90-day waiting period before coverage becomes effective however, and subsidies (both premium subsidies and cost-sharing subsidies) are not available outside the exchange. In every other state, qualifying events are necessary to enroll outside of open enrollment, both on and off-exchange.
  • Employers can purchase group health insurance coverage for their workforce at any time during the year. But an annual open enrollment period will then apply, during which workers can enroll in the plan or make changes to their coverage – and employees who experience various qualifying events have access to the employer-sponsored plan outside of the annual open enrollment period.

For everyone else shopping for their own health insurance – on or off-exchange – a qualifying event will be necessary in order to buy a plan outside of open enrollment.

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