En español l If you want health insurance under the Affordable Care Act (also known as Obamacare) but didn't get it when it first became available, does that mean you're blocked from buying it for another year? And if you bought insurance but your circumstances changed, are you locked into your current plan until the end of the year?
The answer to both questions: Not necessarily. If you meet certain criteria, you may be able to sign up — or even change plans — today.
"It's very important for people to know, so they can take advantage of these opportunities when they arise," says Rachel Klein, an expert on Obamacare at Families USA, a Washington-based health care consumer advocacy group.
Here's what you need to know.
The first open enrollment period to buy an Obamacare plan ended March 31. The next open enrollment — for coverage beginning in 2015 — will run from Nov. 15 to Feb. 15, 2015. But in a number of circumstances — including losing other insurance and, in some cases, not being able to get the website to work — you may be entitled to a special enrollment period (SEP) to sign up at other times of the year, according to officials at the U.S. Department of Health and Human Services.
Obamacare is not for you if you have health insurance coverage from your employer or a government health program such as Medicare or Medicaid. If you don't, though, the law allows you to buy private insurance through an online marketplace regardless of your health or preexisting medical conditions — and in many cases will provide government subsidies to lower the costs of premiums.
If you are entitled to a special enrollment period, you normally get 60 days to sign up after the event that triggered it. Beyond this period, you'd have to wait for open enrollment and you may get penalized for the time that you had no insurance.
Here are 10 circumstances in which you can qualify to sign up for a health plan within the insurance marketplace for the first time — or switch to another plan — without waiting for open enrollment.
1. You tried to enroll during open enrollment but couldn't
You were unsuccessful because of a malfunction on the website; an error made by a government employee; misinformation from an insurance company, agent or counselor; or system errors relating to your immigration status. Some examples:
- You followed the instructions for online enrollment, but a technical glitch didn't allow you to complete the process.
- You were wrongly informed — on the computer or by an agent or counselor — that you did not qualify for a premium reduction and therefore did not complete enrollment because you thought you couldn't afford it.
- You managed to sign up online, but the enrollment failed because it didn't reach the insurance company due to a technical glitch.
- You signed up online, but an error relating to your status as a legal immigrant caused the application to fail.
2. You lose health benefits from an employer
Benefits are no longer available due to the job ending — for any reason — or work hours being reduced. Or you've exhausted COBRA benefits that extend employer health insurance for a limited time. But you can't use a special enrollment period to sign up if you voluntarily drop employer or COBRA coverage, or if it's canceled because you didn't pay the premiums.
3. You lose eligibility for other types of insurance
You no longer qualify for Medicaid or the Children's Health Insurance Program because your circumstances have changed — your income has risen, for example — although you're free to reapply for either of these programs at any time. Or if your college health insurance ends when you graduate. Or you reach age 26 and can no longer stay on your parents' insurance.
4. You managed to enroll during open enrollment, but something went wrong
A special enrollment period can be used to correct something that went wrong. For example:
- You signed up with the help of an official navigator who mistakenly enrolled you in the wrong plan.
- You enrolled in a plan but later found that you qualified for premium reductions that were not applied.
- You based your decision to join a particular plan on incorrect or incomplete information — such as being told by an insurance company or insurance agent that you would have access to many more doctors than the plan actually made available.
5. You move to the United States, or back to the United States after living abroad, or you are released from prison
In all these situations, your 60-day special enrollment period starts on the date of your arrival, return or release.
6 . You were prevented from signing up by exceptional circumstances
For example, you were affected by a serious medical condition or a natural disaster and couldn't sign up during open enrollment.
7. You already have marketplace insurance, but your family circumstances change
You get married, divorced or legally separated. Your family expands through the birth, adoption or fostering of a child. Or someone in your household dies. Each of these "life-changing events" allows you to stay in your current plan or switch to another.
8. You already have marketplace insurance but your income changes
This results in losing federal subsidies that reduce your premiums or becoming newly eligible for such assistance. You can choose to stay in your current plan or switch to another. Note that if you continue to receive subsidies or Medicaid after you're no longer eligible, you could face a large bill from the IRS at the end of the tax year.
9. You already have marketplace insurance, but your residence changes
You move outside of your current plan's service area. Your special period to enroll starts on the day of the move and lasts for 60 days.
10. You are a member of an Indian tribe
If you belong to a federally recognized American Indian or Alaskan Native tribe, you can enroll in marketplace coverage or switch to a different plan at any time of the year.
To apply for a special enrollment period, contact the marketplace call center toll-free at 800-318-2596 (TTY: 855-889-4325). Depending on the circumstances, you may need documentation to show that your situation has changed. If your request for a special enrollment period is denied, you can appeal the decision at healthcare.gov.
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