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Obamacare Special Enrollment – Where to start and What to Consider Before Enrolling

Obamacare Special Enrollment period is a time outside of open enrollment when you and your family can sign up for health insurance in the health insurance marketplace. Here are some key facts about special enrollment to keep in mind:

  • To be eligible for special enrollment, you’ll need to have a qualifying life event that qualifies you for special enrollment in the Healthcare Marketplace (HealthCare.Gov or your state marketplace). You generally also need to have been previously covered under a coverage type that counts as Minimum Essential Coverage (although some life events don’t require this).
  • Qualifying life events include but aren’t limited to: Changes in household size (for example if you get married, have a baby, or a child turns 26), a move to a new home in a new ZIP code or county, losing job-based coverage, losing COBRA coverage, losing individual health coverage for a plan or policy you bought yourself, losing employer coverage, losing eligibility for Medicaid or CHIP, losing eligibility for Medicare, and losing coverage through a family member.
  • You may qualify for a special enrollment period of (typically) 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage.
  • Job-based plans must allow special enrollment periods of 30 days (giving you no less than 30 days to switch to an employer plan from a non-employer plan). If you lose your job you get 60 days to enroll in marketplace coverage.
  • Many special enrollment periods start before you lose coverage, thus giving you time to enroll in a plan and avoid a coverage gap.
  • IMPORTANT: Even though an enrollment period starts 60 days following the day of the event, in most cases you can enroll up to 60 days before the event. This allows your coverage to start on the day of the event and allows people to avoid any gaps in coverage.
  • If you don’t have a special enrollment period, you can’t buy insurance inside or outside the Marketplace until the next open enrollment period.

TIP: In past years open enrollment was extended for those who signed up but had trouble enrolling. This may be true moving forward, or it may not.

The special enrollment period, which extends to May 15, allows Americans in need of health insurance to sign up for coverage through Healthcare.gov. Mr. Biden signed an executive order in late January allowing the Department of Health and Human Services to establish the special enrollment period for uninsured and underinsured Americans to seek coverage through the federal marketplace in light of the “exceptional circumstances” caused by the pandemic.

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Quick List of Qualifying Life Events

Below is a more detailed list, but in short here is a quick list of qualifying life events from HealthCare.Gov:

  • Loss of health coverage
    • Losing existing health coverage, including job-based, individual, and student plans
    • Losing eligibility for Medicare, Medicaid, or CHIP
    • Turning 26 and losing coverage through a parent’s plan
  • Changes in household
    • Getting married or divorced
    • Having a baby or adopting a child
    • Death in the family
  • Changes in residence
    • Moving to a different ZIP code or county
    • A student moving to or from the place they attend school
    • A seasonal worker moving to or from the place they both live and work
    • Moving to or from a shelter or other transitional housing
  • Other qualifying events
    • Changes in your income that affect the coverage you qualify for
    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming a U.S. citizen
    • Leaving incarceration (jail or prison)
    • AmeriCorps members starting or ending their service

If you had one of the above happen, your life is simple, go to HealthCare.Gov and fill out the screener. If you didn’t have one of the above happen, keep reading to find out more about other qualifying life events and hardship exemptions.

Obamacare Special Enrollment – Where to start and What to Consider Before Enrolling

For those interested in the special enrollment period starting in about two weeks, here’s a rundown on where to start and what to consider before enrolling. 

1: Start with HealthCare.gov resources: If you’re not sure where to start, check out HealthCare.gov in the coming weeks. Biden’s executive order directs federal agencies to re-examine any policies that could make it more difficult for people to enroll in Medicaid or the HealthCare.gov insurance plans.

In order to promote the special enrollment period and provide more information, the Centers for Medicare & Medicaid Services will participate in a paid advertising campaign, as well as “direct outreach” to consumers that will be available in English, Spanish and other languages, according to the U.S. Department of Health and Human Services.

Consumers will be able to apply for new coverage or update an existing application through HealthCare.gov, the Marketplace call center or direct enrollment channels such as state-based marketplaces.

2: Understand your income: Before signing up for any plan, it’s crucial to understand what your annual income is — the exact amount, not a ballpark. How much you make directly impacts whether or not you’re eligible for subsidies to reduce the cost of your insurance. 

Too often, people don’t know exactly how much they’ll make in a year. But if they apply and qualify for a subsidy and then end up making more, they’ll owe some of that subsidy back.

There are two types of subsidies: a premium tax credit and cost-sharing subsidies. The tax credit is available to those who buy a marketplace plan and earn a household income between 100% and 400% of the poverty level. In most states, the federal poverty level was $12,760 for an individual last year, according to the Congressional Budget Office.

Those who qualify for the tax credit pay up to just under 10% of their income toward a silver plan. The federal government covers the rest, either on a monthly basis or as a lump sum tax credit. These credits can be applied to any level of plan: bronze, silver, gold and platinum.

But the way the tax credit is currently calculated, if you hit one dollar over 400% of the poverty level, you lose the entire credit, so it’s important to know exactly where you stand before you enroll. 

In addition to the tax credit, some consumers may also qualify for a cost-sharing subsidies. These are only available to those who make between 100% and 250% of the poverty level and sign up for a silver level plan. To help determine how much you may pay and what subsidies you may be eligible for, Kaiser has a helpful calculator. 

“There are a large number of people who qualify for subsidies and don’t know it and can get really cheap health insurance. In 2018, 50% of the uninsured population qualified for Medicaid or subsidies and didn’t know it or didn’t sign up, according to research published last year. That was about 15 million people then and McClanahan says she believes that number is even greater today. 

2: Check out Medicaid: Depending on your situation and where you live, you may qualify for Medicaid. This is a program that provides health coverage for low-income families and children, pregnant women, the elderly and people with disabilities. 

In some states, Medicaid is available for all adults under a certain income threshold. To see if you qualify, HealthCare.gov has a calculator where you can plug in your home state, family size and income level.

In general, it’s worth spending the time to really understand your health insurance options and sign up for a plan, “Even if you have to pay a couple hundred bucks, it’s a lot cheaper than having an emergency and not really having any resources to get the care.

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