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Special Enrollment Periods

Special Enrollment PeriodsThe Affordable Care Act (ACA or ObamaCare) places restrictions on when you can get health insurance. The ACA open enrollment rules are expected to be maintained, under changes proposed by President Trump.

Open enrollment closed on February 1st, 2017 and will re-open on November 1st, 2017 for plans with a January 1st, 2018 start date.   The open enrollment rules hold true for qualified health insurance plans offered to individuals and families through the Connect for Health Colorado, as well as those sold directly by insurance carriers.

Special Enrollment Period Requires a Qualifying Event

After Open Enrollment closes, people can get a new ACA compliant plan if they have a “Qualifying Event” that triggers a Special Enrollment Period.   Please note that acceptable qualifying events may differ between on-exchange and off-exchange, as well as from one carrier to the next. Because of the variability of what qualifying events are acceptable both on and off exchange, it’s important to work with a health insurance broker who can help you find the best value on health insurance for your particular life situation.

Timing is critical!  You can apply up to 60 days before the qualifying event and no more than 60 days after the qualifying event (counting the day of the qualifying event as one of the 60 days).  Let us help you evaluate your plan options available both on and off the Connect for Health Colorado exchange.

Off Exchange Qualifying Events

Common Qualifying Events for insurance carriers:

  • Involuntarily losing other health coverage (see next section)
  • Permanently moves to a new area that offers different health plan options
  • Returns from active military duty
  • Gains immigration status or citizenship
  • Released from incarceration
  • Experienced an error in enrollment

Loss of Health Insurance Coverage Due to:

  • Involuntary loss of employer-sponsored insurance
  • Change in full-time employment status
  • Discontinuation of a current plan that doesn’t meet health care reform requirements
  • Legal separation
  • Divorce
  • Termination of domestic partnership or civil union
  • Death of a parent or spouse
  • Change in dependent status as a result of turning 26

Gaining or Becoming a Dependent Due to:

  • Marriage
  • Domestic partnership
  • Birth of child/children
  • Adoption of child/children
  • Placement for adoption of child/children
  • Guardian/court-ordered dependent

Connect for Health Colorado Qualifying Events

Additionally, Connect for Health Colorado provides these examples of Life Change Events that can help you get new coverage. Events that allow CURRENT customers to shop for a New plan:

  • Change of American Indian/Alaska Native status
  • Change of residence (if moving out of a service area)
  • Gain or loss of eligibility for the tax credit or cost sharing reduction
  • Incorrect or inappropriate enrollment NOT due to a customer error
  • A customer demonstrates that their health plan has substantially violated a provision of its contract

Events that allow NEW customers to SHOP for a health plan:

  • Marriage or civil union
  • Birth or adoption
  • Your employer-provided coverage is no longer available
  • Moving to Colorado from out of state
  • Employer-sponsored coverage becomes unaffordable (Affordable coverage means that an employer offers a health plan for employee-only coverage that does not exceed 9.5 percent of a worker’s W2 income; Costs for dependent coverage are not included in this calculation.)
  • You applied for coverage and financial assistance before April 15 and just received a Medicaid denial
  • You lost eligibility for the exemption to purchase health insurance coverage
  • Gain of Citizenship or Immigration status
  • Change in incarceration status
  • A customer demonstrates that their health plan has substantially violated a provision of its contract

Let us help you evaluate your health insurance plan options available both on and off the exchange.  Our services are completely free and there is no extra cost to use a broker. If you don’t have a qualifying event, you may also want to consider an affordable temporary health insurance plan to help bridge a coverage gap.   Learn More About the ACA or ObamaCare:

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