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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

If 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).

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An executive order signed by President Biden has authorized a COVID-related special enrollment period on, for Americans who don’t currently have health coverage. The SEP will run from February 15 to August 15.

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 (FPL). A single individual can qualify for The Essential Plan for 2020 with an income up to $24,980, and enrollment continues year-round (this income level will be adjusted in late January 2021, when the 2021 poverty level numbers are published).
  • Residents of Massachusetts who qualify for ConnectorCare, as long as they are either newly eligible for ConnectorCare, or are applying for the first time (ie, the ability to enroll year-round in ConnectorCare does have some restrictions). ConnectorCare is available to residents with income up to 300 percent of the federal poverty level, and is subsidized by the state in addition to the premium subsidies and cost-sharing subsidies provided by the ACA.
  • 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.

Qualifying events are not necessary in order to enroll in plans that aren’t considered major medical health insurance, including accident supplements, critical illness plans, short-term health plans, travel insurance, fixed indemnity plans, and other limited benefit plans. But those plans can still reject applicants based on medical history, and they are not considered minimum essential coverage, so relying on them as a sole source of coverage does not count as having health insurance. The termination of those plans is not considered a qualifying event (ie, it doesn’t count as loss of coverage) because the plans are not minimum essential coverage

(If you’re uncertain about your eligibility for a special enrollment period, call (800) 436-1566 to discuss your situation with a licensed insurance professional.)

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Table of Contents

Insider’s Guide to Obamacare’s Special Enrollment Periods
1 Qualifying events and why we need them
2 Who doesn’t need a special enrollment period?
3 Involuntary loss of coverage is a qualifying event
4 How your ‘big move’ can trigger an SEP
5 Divorce, death, or legal separation: SEP is optional
6 A change in subsidy eligibility changes your options
7 Citizenship or lawful immigrant status can deliver coverage
8 An SEP if your employer plan doesn’t measure up
9 Non-calendar-year renewal as a qualifying event
10 Leaving the coverage gap? This SEP’s for you.
11 Proving you deserve an SEP
12 An SEP for your growing family
13 Exceptional circumstances for special enrollment
14 An SEP if you have a QSEHRA or ICHRA

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