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How Individuals can Elect Coverage Outside Open Enrollment

As we transition into 2014, anyone who wants health insurance coverage in the individual market has a window to purchase it.  To get coverage – it must be purchased between January 1 2014 and March 31, 2014.  The date the coverage is purchased will determine when the coverage goes into effect.

If individual insurance coverage is not purchased during this time frame, individuals will have to wait until open enrollment 2014 (later 2014) for a January 1, 2015 effective date, UNLESS the individual has a “Special Qualifying Event”.

Individuals will only be able to elect coverage outside of open enrollment if the individual purchases coverage within 60 days following a qualifying event.  Qualifying event examples include…

  • Getting married
  • Having, adopting, or placement of a child
  • Permanently moving to a new area that offers different health plan options
  • Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
  • For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions

So, if an employer chooses to drop their entire medical plan and they hire a new employee who does not have medical insurance, he or she will not be able to elect coverage in the exchange until open enrollment 2014 with January 1, 2015 effective date (unless the individual is within the time frame allowed to elect the individual coverage through the exchange, if they previously had a special qualifying event occur).