You missed Obamacare's deadline. Now what?
The inaugural six-month open enrollment to buy health insurance on the state exchanges created by the Affordable Care Act has ended, and a two-week extension also has come and gone. About 7.5 million Americans enrolled in health plans through the Obamacare marketplace, and many were helped by federal subsidies to make the cost affordable.
If you are still uninsured, you could face a tax penalty. Unfortunately, while the online exchanges remain open for window shopping, you won't be able to purchase a new policy until the next open enrollment begins on Nov. 15, unless life deals you what health officials define as a "qualifying life event."
How does that work? What are your options outside of the exchanges? And why is there open enrollment anyway?
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Here are 10 things you need to know for the Obamacare offseason, until the exchanges crank up again this fall.
1. Don't give up -- follow up
If you had problems finishing an exchange application on time, don't give up on it.
Obamacare administrators offer special enrollment periods for a variety of "complex cases," including accidental rejection by the insurer, error messages and even incidents in which you were misled by an insurance agent or prevented from completing your application due to domestic abuse or a natural disaster.
"These special cases are for specific situations where a consumer was not able to successfully complete enrollment during the open enrollment period despite their efforts to do so and through no fault of their own," a spokesperson for the Centers for Medicare & Medicaid Services, who requested anonymity, said in an email.
"You need to follow up," says Judy Feder, a health policy expert with the Urban Institute, a nonpartisan think tank in Washington, D.C. "If you applied on the federal exchange or on many state exchanges, your application may still be in play."
2. Life changes bring special enrollment
Other ways to get a special enrollment period are if you:
- Marry or divorce.
- Have or adopt a child.
- Place a child for adoption or in foster care.
- Experience a change in household status or income that affects your eligibility for federal subsidies and tax credits under an existing exchange policy.
These are a few of the situations called "qualifying life events" that allow you to shop in the exchanges after the open enrollment window has closed.
There are several other examples, such as if you have a lapse in health coverage due to a job loss, or if you're a young adult who has "aged out" of a parent's plan by turning 26.
If your application for special enrollment is approved, you'll generally have 60 days to shop for and purchase a plan on your state's exchange.
3. Even newbies can get special enrollment
If you've never logged onto HealthCare.gov or your state's health exchange, you can still apply for a special enrollment period if you experience a qualifying life event, according to the CMS spokesperson.
But you won't qualify if you voluntarily drop your health insurance or your insurer cancels a plan that falls short of Obamacare's definition of "minimum essential coverage."
"Just the changes that come with everyday life and the dynamic economy will generate many qualifying events," says Deborah Chollet, a health insurance research leader at Mathematica Policy Research in Washington, D.C.
"The exchanges aren't 'down' for six months, by any means," she says. "I expect an ongoing inflow of business to the exchanges."
4. Medicaid enrollment never closes
The door never closes on applying for coverage through Medicaid or the Children's Health Insurance Program, or CHIP, the federal "safety net" health programs for low-income adults and children. More low-income adults are now eligible to apply for coverage in the District of Columbia and the 25 states that exercised their option to expand Medicaid under Obamacare.
5. Insurers like limited enrollment season
Why is there open enrollment, anyway? The short answer is: Because otherwise, consumers could purchase coverage only when they get sick and drop it when they recover.
Insurers call this "adverse selection." It would quickly leave insurance companies neck-deep in bills with little revenue to pay them.
6. Special enrollment denied? Appeal!
The first part of Obamacare's full, official title -- The Patient Protection and Affordable Care Act of 2010 -- provides consumers with the right to appeal a variety of negative rulings, including being denied a special enrollment period.
If you feel your life event has been unfairly disqualified, HealthCare.gov has a page where you can learn how to appeal the decision through your state exchange.
7. Private market is largely closed, too
Now that open enrollment is closed for the Obamacare exchanges, can you still buy a health insurance policy on the private market?
It may be tough.
Insurers have a disincentive to offer qualified plans outside of open enrollment. Obamacare's "guaranteed issue" requirement says they can no longer deny coverage or charge more due to age, gender or a pre-existing health condition, and insurers are wary of the "adverse selection" mentioned earlier.