Understanding ACA enrollment periods is crucial for agents offering the plans as well as for potential enrollees. We will go over the opportunities both individuals and families have to enroll in health coverage.
Open Enrollment Period
The Open Enrollment Period (OEP) is the primary time each year individuals and families can sign up for health insurance through the ACA marketplace. Each year, the OEP begins November 1st and ends on January 15th. In some cases, the enrollment deadline is extended for a specific reason.
Important dates:
November 1st – Open enrollment begins. Coverage starts January 1st.
December 15th – This s the last day to enroll in or change plans for coverage to start January 1st.
January 1st – Coverage begins for anyone who enrolled in a plan by December 15th nd paid their premium.
January 15th – Open enrollment ends; this is the last day of the year individuals/families can either enroll in or change healthcare plans without a Special Enrollment period.
February 1st – Coverage begins for those who enrolled between December 16th and January 15th and paid their first premium.
During this enrollment period, individuals/families can:
- Enroll in a new health insurance plan.
- Renew their current plan.
- Make changes to an existing plan.
Please note: Plans for those who use the OEP for enrollment begin on January 1st of the following year. Those who miss the OEP may not be able to enroll in or change their current plan until the next year’s OEP, unless they qualify for a Special Election Period.
Special Enrollment Period
The Special Enrollment Period (SEP) allows individuals/families to either enroll in or change health insurance plans outside the OEP. The SEP is available to those who experience specific life events.
These life events include:
Loss of health coverage: What qualifies as loss of health coverage; loss of either job-based coverage, Medicaid, or CHIP.
Changes in household: Here are examples of changes in a household; getting married or divorced, either having a baby or adopting a child, or a death in the family.
Changes in residence: This includes; moving to a different zip code or county, another state, or when you move to or from the place where you attend school.
Other qualifying events: Changes in your income (gains or losses) that affect the coverage you qualify for, gaining membership in a federally recognized tribe, becoming a U.S. citizen, leaving incarceration, or AmeriCorps members who are either starting or ending their service.
In most cases, the individual/family has 60 days from the date of the qualifying event to enroll in a plan through the SEP.
Medicaid and CHIP Enrollment
Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost coverage to millions of Americans, including qualifying low-income people, families and children, pregnant women, the elderly, and people with disabilities. Unlike marketplace plans, you can apply for and enroll in Medicaid and CHIP any time of the year. Remember; enrollment in either Medicaid or CHIP gives the enrollee an SEP for a marketplace plan.
If you are an insurance agent, here are some helpful links:
Click here to watch a video on Crowe ACA offerings for agents & agencies
Watch a demo of our ACA agent portal
Click here to add ACA to your Crowe contracts
Enrollment tips
- Mark Your Calendar: Keep track of important dates for the OEP and plan ahead to gather necessary documents and information.
- Check for SEP Eligibility: Those who miss the OEP, should check if they qualify for an SEP.
- Explore Medicaid and CHIP: If your income is low, you may qualify for Medicaid or CHIP, which have year-round enrollment.
- Compare Plans: Compare different plans available in the marketplace to find one that best suits your needs and budget.
- Seek Assistance: Navigating health insurance can be complex. Don’t hesitate to seek help from certified navigators, agents, or brokers.
Understanding and taking advantage of the ACA enrollment periods is essential to ensure you have the health coverage you need.
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