Experiencing a qualifying life event allows you to apply for Affordable Care Act (ACA) health insurance coverage outside of the annual ACA open enrollment period.
The ACA created a nationwide open enrollment period for on-marketplace plans (carriers are permitted to have different open enrollment periods for off-marketplace plans but with few exceptions most carriers follow the on-marketplace rules).
Open enrollment on the Federal Facilitated Marketplace for 2021 plans ran from November 1, 2020 through December 15, 2020 for a January 1, 2021 effective date. During open enrollment individuals and families could purchase ACA plans without having to meet any requirements other than to be legal U.S. residents, not be incarcerated, and not be eligible for Part A of Medicare.
Now that open enrollment has ended, you can only purchase an Obamacare plan if you experience a major life changing event (termed a "qualifying life event" under the law).
What Are Some Qualifying Life Events?
Qualifying life events that may trigger a special enrollment period for yourself and your family outside of the ACA's open enrollment period include the following:
- Marriage or divorce
- The birth or adoption of a child
- The loss of employer-based health insurance coverage
- Moving to a new city outside your old plan’s coverage area
- Changes in income (generally at least 20%) that affect your eligibility for a subsidy
- Loss of Medicaid
Be aware that in most cases you will need to provide documentation showing that you experienced one of these (or other) qualifying life events and that you generally will have to show that you had continuous coverage (i.e. you were covered by some other plan for at least one day in the sixty days prior to the event).
The following applies to residents of states (e.g. Florida) that participate in the Federal Facilitated Marketplace (healthcare.gov):
How Long Will I Have To Enroll In A New Plan?
If you experience a qualifying life event, in most cases you will have a sixty-day window during which you can enroll in a new ACA health insurance plan and apply for an ACA subsidy if you meet the income criteria.
What To Do If You Missed the Affordable Care Act Open Enrollment Deadline
- Determine if you have a qualifying life event that permits you to enroll in an ACA plan. Note that regulations require (1) proof of occurrence and (2) in most cases proof that you were covered by an ACA plan within 60 days of the event's occurrence
Enter the required information (as well as the optional information to receive a subsidy determination) and submit a quote request form. We'll contact you to review premiums (less any subsidy), available plans, whether your doctor accepts the plan, and how your medications are covered.
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