A Guide for Those Who Missed the ACA Open Enrollment Deadline

A Guide for Those Who Missed the ACA Open Enrollment Deadline

If you find yourself reading this article, it’s likely that you missed the deadline for the Affordable Care Act (ACA) Open Enrollment. The Open Enrollment Period for most people ended on January 15, 2022, in most states, although some states had a later deadline on January 31st. Don’t worry; you’re not alone in missing the deadline. Many people have various reasons for missing it, according to David Anderson, a research associate at the Duke-Margolis Center for Health Policy in Durham, North Carolina.

There are a few options available to you if you missed the January 2022 deadline and still want to apply for ACA benefits:

  1. If your income is 150% of the poverty level or less, you can still apply for ACA benefits. This means earning $19,320 or less per year for a single person or $32,940 or less for a family of three. To apply, you can file an application on the federal marketplace’s website and provide your income details when prompted. In some cases, you may need to submit documents such as a recent pay stub to verify your income.
  2. Native Americans and Alaska Natives have different rules under the ACA and can enroll in a health plan year-round. If you belong to either of these groups, you can enroll by the 15th of any month, and your coverage will start on the first day of the following month.
  3. You may qualify for a Special Enrollment Period (SEP) if you have experienced a qualifying life event. Some common qualifying events include getting married, divorced, or legally separated, having a baby or adopting a child, moving to a new area where different health plans are available, losing insurance due to job loss or turning 26 and losing coverage under your parents’ plan, or being affected by a hurricane or technical error on the federal marketplace’s website while applying for ACA benefits. Another important qualifying event is if you applied for Medicaid or the Children’s Health Insurance Program (CHIP) during Open Enrollment but were denied access after the period ended.

However, it’s important to note that SEPs have limitations, and you should apply for a plan as soon as possible if you believe you qualify. Typically, the window for applying is 60 days from the date of the qualifying event, not from the time you submit the application. If the deadline is approaching and you need more time, there may be extensions available. But once the deadline passes, you’ll need to wait for another qualifying event to apply again.

During the SEP, you can change plans, but there are restrictions. For example, if you move to an area with different health plans, you need to have had coverage before the move to trigger an SEP. Similarly, it’s the loss of insurance, not the loss of a job, that qualifies for an SEP. Additionally, when changing plans, you will generally have to choose a plan at the same cost level as your previous one. ACA plans are categorized as bronze, silver, gold, or platinum, based on cost, and you will typically have to select a new plan from the same category as your current one.

When applying for an SEP, be prepared to provide proof of your qualifying event. For example, if you got married, you may need to provide your marriage license, and for a new baby, you may need to show the birth certificate dated after the Open Enrollment Period ended. Insurers will review the documentation you provide to determine its sufficiency, and they may request additional documents if necessary.

If you qualify for Medicaid or CHIP, you don’t have to enroll in ACA benefits. You can apply for these programs at any time during the year through the federal marketplace or your state-run exchange. The state agency usually has 45 days to process your application, although it may happen even quicker if your application is straightforward. Medicaid eligibility is typically based on annual income below 138% of the federal poverty level, although the threshold may vary in different states. CHIP provides low-cost coverage for children whose families earn too much to qualify for Medicaid. To avoid missing the ACA Open Enrollment deadline in the future, it’s important to plan ahead. Mark the next year’s Open Enrollment Period on your calendar, which usually begins on November 1. Making the process as easy as possible can increase the likelihood of completing it. Research shows that people who sign up for zero-premium plans, which have no monthly cost, are more likely to activate their coverage on January 1. The absence of an initial payment saves time and money, making it more convenient.

Applying for insurance doesn’t have to be a lengthy process. By being prepared and organized, you can save a significant amount of time. Before you start, gather the necessary information, such as Social Security numbers for everyone on your application, banking and credit card statements (which may be required for identity verification), and an estimate of your household income. Answering four key questions ahead of time can help you narrow down your choices efficiently: which prescription medications you want covered, which doctors or providers you want to use (including your nearest hospital), how much you can afford to spend on health insurance each month, and how much you can afford to pay in case of unexpected medical expenses. Enrolling in health coverage is essential, even if you consider yourself healthy and don’t anticipate immediate healthcare needs. Health insurance provides financial protection in the event of accidents or unexpected illnesses. Additionally, ACA marketplace plans often cover preventive services, such as blood pressure, cholesterol, and depression screenings. If you missed the ACA Open Enrollment deadline, there are still options available to apply for ACA benefits. Understanding the eligibility criteria for Special Enrollment Periods and Medicaid or CHIP can help you navigate the process successfully. By being proactive and planning for future Open Enrollment Periods, you can ensure that you have the health coverage you need.