When the annual sign-up period for individual Obamacare coverage ended earlier this month, it meant that in general, people are locked into their plans for the year. There are exceptions, however, for those who experience life changes such as marriage, the birth of a child or the loss of their job-based coverage.
The list of situations that trigger a special, 60-day enrollment period will get longer in April, when a new rule issued by the Department of Health and Human Services takes effect.
The rule’s additional circumstances include:
— Losing a dependent or dependent status because of divorce, legal separation or death. This provision would enable someone who no longer needs family coverage, for example, to switch to single coverage. Although not required until 2017, exchanges are encouraged to offer this as soon as possible.
— An increase in an individual’s income to the federal poverty level in states that haven’t expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level ($16,243 in 2015). At that income level, the person could qualify for premium tax credits that are available for those with incomes between 100 and 400 percent of the poverty level to make marketplace coverage more affordable.
Last year, such individuals could also qualify for a special enrollment period, “but we read this as a bit broader,” says Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. Last year, “you had to have applied for Medicaid to qualify.” Now, that’s not necessary.
–If a court order requires someone to provide health insurance, the coverage must be available the first day the court order takes effect.
“It’s extremely important for ensuring the coverage of children,” says Dania Palanker, senior counsel at the National Women’s Law Center.
–People who are currently enrolled in non-calendar year plans will qualify for a special enrollment period when that coverage ends, even if they could renew them.
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