Health Insurance: Why You Need It
The benefits of having health insurance include being able to manage your health care needs as well as costs. There is a health plan to fit almost every need. You or your covered dependents can receive medical care with the help of health insurance. In the absence of it, you may have to pay the full cost of all your medical treatment.
It is only possible to sign up for health insurance or make changes during an open enrollment period. Unless you qualify for a special enrollment period (SEP), you will have to wait until next year’s open enrollment. Your health insurance plan can be changed outside of open enrollment during a Special Enrollment Period. SEPs are only available to people who have experienced a certain life event or have special circumstances.
The Open Enrollment Period
Each year, you can enroll in a health insurance plan during open enrollment. It is during this period that you can change your current plan or obtain new coverage. The open enrollment period applies to employer-sponsored health insurance plans as well as individual health insurance plans (purchased directly from an insurer or through your state’s insurance marketplace).In order to prevent adverse selection, health plans limit coverage to an open enrollment period. Companies that offer health insurance face a large financial burden due to adverse selection.
The open enrollment period for individual plans purchased through the government-run insurance marketplace or directly from an insurance company runs from November 1 to December 15 for plans that begin on January 1. The open enrollment period may be extended by state-run marketplaces before and after the national open enrollment period. You should check the open enrollment periods if you purchase your insurance through a state marketplace.
Open Enrollment Exceptions
It is possible to enroll without a special enrollment period when there are some exceptions to open enrollment. The Children’s Health Insurance Program (CHIP) and Medicaid are available all year round.If you turn 65 before enrolling in Medicare, you have seven months to do so. If you do not qualify for SEP, your changes can only be made during open enrollment.
Taking advantage of a Special Enrollment Period
There are certain circumstances under which all health insurance plans, whether they are purchased through the marketplace, directly from an insurer, or through your employer, offer a special enrollment period. Special enrollment periods are available for people who have lost their current health coverage or experienced a life change such as marriage or childbirth. You will have a special enrollment period if you experience a qualifying event, so you can enroll in a new health plan or change your current coverage.
A SEP occurs 60 days after an event for individuals with individual health insurance plans. A SEP under an employer-based plan can be shorter, but it must be at least 30 days long. Depending on the circumstance (e.g., a marriage, birth, or adoption), you may have 60 days before the event to enroll.
If you enroll by the 15th of the month, coverage will usually start on the first of the following month. Your state or federal exchange, insurer, or employer can provide you with guidelines and exact lengths of SEPs. In case any issues arise, it’s advisable to make any changes as soon as your SEP begins even if you have up to 60 days to do so. Those who miss the deadline must wait for open enrollment.
Events that qualify for the Special Enrollment Period
Your health insurance needs are affected by a qualifying event when you have a major life change. An eligible event triggers a special enrollment period, which allows you to purchase health insurance or make changes to your coverage outside of the annual open enrollment season.
A few examples of qualifying events are as follows:
- Events that qualify
- Becoming a citizen of the United States
- Your premiums can be lowered due to new tax credits (for Marketplace plans)
- Jail release or release from prison
- A natural disaster or unexpected hospitalization may constitute exceptional circumstances
- A survivor of domestic violence or abandonment by their spouse
- You lose your qualifying health insurance coverage (except if you do not pay your premiums)
- No longer eligible for Medicaid or CHIP
- Loss of employer-based health insurance
- Your parents’ insurance coverage ends when you turn 26
- Residence Relocation
- When you move permanently to another state or outside the coverage area of your insurance plan
- An incoming or departing college student
- The process of moving into or out of a shelter or transitional housing
- A change in household or family structure
- An engagement or a divorce
- Adopting a child/giving birth to a child
- (Only for New York) Pregnancy
- A spouse or dependent suffers a fatal illness
A special enrollment period is not automatically granted to you just because you have one of the qualifying events. It is essential that any changes to your coverage correspond to your qualifying event and must be approved. The special enrollment period does not apply if you get married and don’t add your spouse to your insurance plan.
Special Enrollment Period Application
Get in touch with our licensed Insurance agents today to find out what options are available to you. In the event that you qualify for a Special Enrollment Period, we will be able to provide you with quotes as soon as possible if you do.