What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA, and generally referred to as Obamacare – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010.

The legislation includes a long list of health-related provisions that began taking effect in 2010. Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate industry practices that include rescission and denial of coverage due to pre-existing conditions.

The law includes premium subsidies and cost-sharing subsidies designed to reduce the costs of coverage for Americans who qualify. (Find out if you’re eligible for subsidies with this subsidy calculator.) Millions also gained coverage due to the law’s expansion of Medicaid in many states.

Millions of American enroll in ACA-compliant health plans during an annual open enrollment period (OEP). However, many Americans can enroll outside of the OEP if they have a qualifying life event, which makes them eligible for a special enrollment pe

Source: https://www.healthinsurance.org/glossary/affordable-care-act/
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Questions and Answers on the Individual Shared Responsibility Provision

Basic Information
1. What is the individual shared responsibility provision?
Under the Affordable Care Act, the federal government, state governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. Starting in 2014, the individual shared responsibility provision calls for each individual to have qualifying health care coverage (known as minimum essential coverage) for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.

Under the recently enacted Tax Cuts and Jobs Acttax law, taxpayers must continue to report coverage, qualify for an exemption, or pay the individual shared responsibility payment for tax years 2017 and 2018.

2. Who is subject to the individual shared responsibility provision?
The provision applies to individuals of all ages, including children. The adult or married couple who can claim a child or another individual as a dependent for federal income tax purposes is responsible for making the payment if the dependent does not have coverage or an exemption.

3. When does the individual shared responsibility provision go into effect?
The provision went into effect on Jan. 1, 2014. It applies to each month in the calendar year.

4. Is transition relief available in certain circumstances for 2014?
Yes. Notice 2013-42, published on June 26, 2013, provides transition relief from the shared responsibility payment for individuals who are eligible to enroll in eligible employer-sponsored health plans with a plan year other than a calendar year (non-calendar year plans) if the plan year begins in 2013 and ends in 2014 (2013-2014 plan year). The transition relief applies to an employee, or an individual having a relationship to the employee. The transition relief began in January 2014 and continues through the month in which the 2013-2014 plan year ends.

In addition, Notice 2014-10, published on Jan. 23, 2014, provides transition relief for individuals covered under certain limited-benefit government-sponsored programs. Coverage under these programs is not minimum essential coverage unless it is designated as such by the Department of Health and Human Services. Under Notice 2014-10, individuals who have coverage under these government-sponsored programs will not be held liable for the shared responsibility payment for months in 2014 when they have that coverage. The specific government-sponsored programs are optional family planning coverage of family services under title XIX of the Social Security Act, optional coverage of tuberculosis-related services under title XIX of the Social Security Act, coverage of pregnancy-related services under title XIX of the Social Security Act, coverage limited to treatment of emergency medical conditions (in accordance with section 1611(b)(12)(A) of title 8 of the United States Code) under title XIX of the Social Security Act, coverage for medically needy individuals under title XIX of the Social Security Act, coverage authorized under section 1115(a)(2) of the Social Security Act, limited-benefit TRICARE coverage of space available care provided under chapter 55 of title 10 of the United States Code and limited-benefit TRICARE coverage of line of duty care under chapter 55 of title 10 of the United States Code.

5. What counts as minimum essential coverage?
Minimum essential coverage includes the following:

Employer-sponsored coverage, including self-insured plans, COBRA coverage and retiree coverage
Coverage purchased in the individual market, including a qualified health plan offered by the Health Insurance Marketplace, health insurance offered by certain student health plans and catastrophic coverage
Medicare Part A coverage and Medicare Advantage plans
Most Medicaid coverage
Children’s Health Insurance Program (CHIP) coverage
Certain types of veterans health coverage administered by the Veterans Administration
Most types of TRICARE coverage under chapter 55 of title 10 of the United States Code
Coverage provided to Peace Corps volunteers
Coverage under the Nonappropriated Fund Health Benefit Program
Refugee Medical Assistance supported by the Administration for Children and Families
Coverage through a Basic Health Program (BHP) standard health plan
Coverage under an expatriate health plan
Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these programs may apply to HHS to be recognized as minimum essential coverage)
State high risk pools for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these program may apply to HHS to be recognized as minimum essential coverage)
Other coverage recognized by the Secretary of HHS as minimum essential coverage
Minimum essential coverage does not include coverage providing only limited benefits, such as the following:

Coverage consisting solely of excepted benefits, such as:
Stand-alone vision care or dental care
Workers’ compensation
Accident or disability policies
Medicaid providing only family planning services
Medicaid providing only tuberculosis-related services
Medicaid providing only coverage limited to treatment of emergency medical conditions
Pregnancy-related Medicaid coverage*
Medicaid coverage for the medically needy*
Section 1115 Medicaid demonstration projects*
Space available TRICARE coverage provided under chapter 55 of title 10 of the United States Code for individuals who are not eligible for TRICARE coverage for health care services from private sector providers*
Line of duty TRICARE coverage provided under chapter 55 of title 10 of the United States Code*
* Medicaid programs that provide limited benefits generally do not qualify as minimum essential coverage. However, HHS will provide a hardship exemption to individuals with certain types of limited-benefit Medicaid coverage.

6. What are the statutory exemptions from the requirement to have minimum essential coverage?
Religious conscience. You are a member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.
Health care sharing ministry. You are a member of a health care sharing ministry.
Indian tribes. You are (1) a member of a federally recognized Indian tribe or (2) an individual eligible for services through an Indian care provider.
Income below the income tax return filing requirement. Your income is below the minimum threshold for filing a tax return. The requirement to file a federal tax return depends on your filing status, age and types and amounts of income. To find out if you are required to file a federal tax return, use the IRS Interactive Tax Assistant (ITA).
Short coverage gap. You went without coverage for less than three consecutive months during the year. For more information, see question 22.
Hardship. You have suffered a hardship that makes you unable to obtain coverage, as defined in final regulations issued by the Department of Health and Human Services. See question 21 for more information on claiming hardship exemptions..
Affordability. You can’t afford coverage because the minimum amount you must pay for the premiums is more than a certain percentage of your household income.
Incarceration. You are in a jail, prison, or similar penal institution or correctional facility after the disposition of charges against you.
Not lawfully present. You are not lawfully present in the U.S. and are not a U.S. citizen, or U.S. national.
7. What do I need to do if I want to be sure I have minimum essential coverage or an exemption?
The vast majority of coverage that people have today is minimum essential coverage. For those who do not have coverage, who anticipate discontinuing the coverage they have currently, or who want to explore whether more affordable options are available, the Health Insurance Marketplace is open in every state and the District of Columbia. The Marketplace helps individuals compare available coverage options, assess their eligibility for financial assistance and find minimum essential coverage that fits their budget.

For those seeking an exemption from the individual responsibility provision, the Marketplace is able to provide certificates of exemption for some of the exemption categories. HHS has issued final regulations on how the Health Insurance Marketplace grants these exemptions. Individuals will also be able to claim most exemptions when they file their federal income tax returns. Individuals who are not required to file a federal income tax return because their gross income falls below the return filing threshold do not need to take any further action to secure an exemption. See question 21 for further information on how to claim an exemption.

For more information about the Marketplace, visit the Health Insurance Marketplace website. For more information about financial assistance, see our Questions and Answers on the premium tax credit.

8. Is more detailed information available about the individual shared responsibility provision?
Yes. The Treasury Department and the IRS have issued final regulations on the individual shared responsibility provision, and final regulations on minimum essential coverage and certain exemptions. In addition, the IRS has created an individual shared responsibility page. Further information on exemptions and minimum essential coverage is available in final regulations issued by the Department of Health and Human Services.

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Who is Affected
9. Are children subject to the individual shared responsibility provision?
Yes. Each child must have minimum essential coverage or qualify for an exemption for each month in the calendar year. Otherwise, the adult or married couple who can claim the child as a dependent for federal income tax purposes will generally owe a shared responsibility payment for the child.

10. Are senior citizens subject to the individual shared responsibility provision?
Yes. Senior citizens must have minimum essential coverage or qualify for an exemption for each month in a calendar year. Both Medicare Part A and Medicare Part C (also known as Medicare Advantage) qualify as minimum essential coverage.

11. Are all individuals living in the United States subject to the individual shared responsibility provision?
All U.S. citizens living in the United States are subject to the individual shared responsibility provision as are all permanent residents and all foreign nationals who are in the United States long enough during a calendar year to qualify as resident aliens for tax purposes. This category includes nonresident aliens who meet certain presence requirements and elect to be treated as resident aliens. For more information see Pub. 519.

Foreign nationals who live in the United States for a short enough period of time that they do not become resident aliens for federal income tax purposes are exempt from the individual shared responsibility payment even though they may have to file a U.S. income tax return. The IRS has more information available on when a foreign national becomes a resident alien for federal income tax purposes. Individuals who are exempt under this rule include:

Nonresident aliens;
Dual-status aliens in their first year of U.S. residency;
Nonresident aliens or dual-status aliens who elect to file a joint return with a U.S. spouse;
Individuals who file a Form 1040NR or Form 1040NR-EZ (including a dual-status tax return for their last year of U.S. residency); and
Individuals who are claimed as a personal exemption on a Form 1040NR or Form 1040NR-EZ.
In addition, individuals who are not lawfully present in the United States and not U.S. citizens or U.S. nationals are exempt from the individual shared responsibility provision. For this purpose, an immigrant with Deferred Action for Childhood Arrivals (DACA) status is considered not lawfully present and therefore is eligible for this exemption. An individual may qualify for this exemption even if he or she has a Social Security number (SSN).

Individuals who file a Form 1040NR or Form 1040NR-EZ, or are claimed as a personal exemption on one of those forms, do not need to take any action to claim an exemption from the individual shared responsibility provision. Other individuals who qualify for an exemption and file a U.S. income tax return should attach Form 8965, Health Coverage Exemptions, to claim the exemption.

12. Are US citizens and U.S. residents living abroad subject to the individual shared responsibility provision?
Yes. However, U.S. citizens who are physically present in a foreign country or countries for at least 330 full days during any period of 12-consecutive months are exempt from the individual shared responsibility payment for any month in the tax year that is included in that 12-month period. In addition, U.S. citizens who are bona fide residents of a foreign country (or countries) for an uninterrupted period which includes an entire taxable year are exempt for that year. Resident aliens who are citizens or nationals of a foreign country with which the U.S. has an income tax treaty with a nondiscrimination clause, and who are bona fide residents of a foreign country for an uninterrupted period that includes an entire tax year also are exempt. In general, these U.S. citizens and U.S. residents are individuals who qualify for a foreign earned income exclusion under section 911 of the Internal Revenue Code. Individuals may qualify for this exemption even if they cannot use the exclusion for all of their foreign earned income because, for example, they are employees of the United States. See Publication 54, Tax Guide for U.S. Citizens and Resident Aliens Abroad, for further information on the foreign earned income exclusion. Individuals who qualify for this exemption should file Form 8965, Health Coverage Exemptions, with their federal income tax returns.

U.S. citizens who meet neither the physical presence nor residency requirements will need to maintain minimum essential coverage, qualify for a coverage exemption or make a shared responsibility payment. For this purpose, minimum essential coverage includes a group health plan provided by an overseas employer and certain expatriate health plans. One exemption that may be particularly relevant to U.S. citizens living abroad for a small part of a year is the exemption for a short coverage gap. This exemption provides that no shared responsibility payment will be due for a once-per-year gap in coverage that lasts less than three months. See Question 22 for more information on the short coverage gap exemption.

13. Are residents of the territories subject to the individual shared responsibility provision?
All bona fide residents of the United States territories are exempt from the individual shared responsibility provision. Individuals who qualify for this exemption should file Form 8965, Health Coverage Exemptions, with their federal income tax returns.

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Minimum Essential Coverage
14. If I receive my coverage from my spouse’s employer, will I have minimum essential coverage?
Yes. Employer-sponsored coverage generally is minimum essential coverage. (See question 5 for information on specialized types of coverage that are not minimum essential coverage.) If an employee enrolls in employer-sponsored coverage for himself and his family, the employee and all of the covered family members have minimum essential coverage.

15. Do my spouse and dependent children have to be covered under the same policy or plan that covers me?
No. You, your spouse and your dependent children do not have to be covered under the same policy or plan. However, you, your spouse and each dependent child for whom you may claim a personal exemption on your federal income tax return must have minimum essential coverage or qualify for an exemption, or you will owe a shared responsibility payment when you file a return.

16. My employer tells me that our company’s health plan is “grandfathered.” Is my employer’s plan minimum essential coverage?
Yes. Grandfathered group health plans are minimum essential coverage.

17. I am a retiree, and I am too young to be eligible for Medicare. I receive my health coverage through a retiree plan made available by my former employer. Is the retiree plan minimum essential coverage?
Yes. Retiree health plans generally are minimum essential coverage.

18. I work for a local government that provides me with health coverage. Is my coverage minimum essential coverage?
Yes. Employer-sponsored coverage is minimum essential coverage regardless of whether the employer is a governmental, nonprofit or for-profit entity.

19. Do I have to be covered for an entire calendar month to avoid the shared responsibility payment liability for not having minimum essential coverage for that month?
No. You will be treated as having minimum essential coverage for a month as long as you have coverage for at least one day during that month.

20. If I change health coverage during the year and end up with a gap when I am not covered, will I owe a payment?
Individuals are treated as having minimum essential coverage for a calendar month if they have coverage for at least one day during that month. Additionally, as long as the gap in coverage is less than three consecutive months, you may qualify for an exemption and not owe a payment. See question 22 for more information on the exemption for a short coverage gap.

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Exemptions
21. If I think I qualify for a coverage exemption, how do I obtain it?
It depends on the coverage exemption for which you may qualify.

The religious conscience exemption and most hardship exemptions are available only by going to the Health Insurance Marketplace (Marketplace) and applying for an exemption certificate. Information on obtaining these exemptions is available in final rules issued by the Department of Health and Human Services.
The exemptions for members of Federally-recognized Indian tribes, other individuals eligible for services from an Indian health care facility, members of health care sharing ministries and individuals who are incarcerated generally were available either by going to the Marketplace and applying for an exemption certificate or by claiming the exemption as part of filing a federal income tax return. However, the Federally-facilitated Marketplace is no longer granting these exemptions. Eligible individuals can still claim these exemptions as part of filing a federal income tax return.
The exemptions for individuals who lacked access to affordable coverage, had a short coverage gap, experienced certain hardships, had income below their filing threshold, or who were not lawfully present in the United States may be claimed only as part of filing a federal income tax return.
You will claim or report coverage exemptions on Form 8965, Health Coverage Exemptions, and file it with your Form 1040, Form 1040A, or Form 1040EZ. These forms can all be prepared and filed electronically.

See question 25 for more information on Form 8965.

22. What qualifies as a short coverage gap?
In general, a gap in coverage that lasts less than three months qualifies as a short coverage gap. If you have more than one short coverage gap during a year, the short coverage gap exemption only applies to the first gap.If you have a coverage gap of 3 months or more, you are not exempt for any of those months.

If you do not have coverage for a continuous period that begins in one taxable year and ends in the next, for purposes of applying the short coverage gap rules to the first taxable year, the months in the second taxable year included in the continuous period are not counted. For purposes of applying the short coverage gap rules to the second year, the months in the first taxable year are counted. For example, if you lacked coverage from November 1, 2016 until February 1, 2017, November and December of 2016 are treated as a short coverage gap on your 2016 tax return. On your 2017 return, however, November and December of 2016 are included in the continuous period that includes January 2017. That continuous period is not less than 3 months so, on your 2017 return, January of 2017 is not an exempt month under the short coverage gap exemption.

23. If my income is so low that I am not required to file a federal income tax return, do I need to do anything special to claim an exemption from the individual shared responsibility provision?
No. If you are not required to file a federal income tax return for a year because your gross income is below your return filing threshold, you are automatically exempt from the shared responsibility provision for that year and do not need to take any further action to secure an exemption. If you are not required to file a tax return for a year but file one anyway, you will be able to claim the exemption on Form 8965 filed with your tax return.

24. If I am exempt from the shared responsibility payment, can I still be eligible for the premium tax credit?
In many cases, yes, but it depends upon the exemption. If you are exempt because you are incarcerated or because you are not lawfully present in the United States, you are not eligible to enroll in a qualified health plan through the Marketplace and therefore cannot claim a premium tax credit for your own coverage. However, individuals with other types of exemptions may obtain coverage through the Marketplace and claim a premium tax credit if they otherwise qualify for the credit.

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Reporting Coverage or Exemptions or Making Payments
25. Does the individual shared responsibility provision affect my federal tax return?
Yes. You will account for coverage or coverage exemptions or make a payment when you file your federal tax return. Beginning with the 2015 calendar year, insurers and other coverage providers will be required to provide certain information to everyone they cover during the year. This information, which may be reported on a Form 1095-A, 1095-B or 1095-C, will help individuals demonstrate they had coverage during the calendar year. See Health Care Information Forms Questions and Answers for more information about Form 1095-A, 1095-B or 1095-C.

26. How do I report that I had coverage for each month of the year?
If you and all of your dependents had coverage for each month of the tax year, you will indicate this on your tax return simply by checking a box on your Form 1040, 1040A or 1040EZ.

27. How do I report or claim a coverage exemption on my tax return?
You claim or report coverage exemptions on Form 8965, Health Coverage Exemptions, and file it with your Form 1040, Form 1040A, or Form 1040EZ. These forms can all be prepared and filed electronically. However, if your gross income is below your applicable minimum threshold for filing a federal income tax return, you are exempt from the individual shared responsibility provision and are not required to file a federal income tax return solely to claim the coverage exemption. If you file a return anyway (for example, to claim a refund), you can claim your coverage exemption on Form 8965 filed with your return.

If you are granted a coverage exemption from the Marketplace, they will send you a notice with your unique Exemption Certificate Number or ECN. Keep this notice with other important tax information.

You will enter your ECN in Part I, Marketplace-Granted Coverage Exemptions for Individuals, of Form 8965 in column C.

If the Marketplace hasn’t processed your exemption application before you file your tax return, complete Part I of Form 8965 and enter “pending” in Column C for each person listed. If you claim the exemption on your tax return, you do not need an ECN from the Marketplace.

For a coverage exemption that you qualify to claim on your tax return, all you need to do is file Form 8965 with your tax return – you do not need to call the IRS or obtain the exemption in advance.

You will use Part II, Coverage Exemptions for Your Household Claimed on Your Return, of Form 8965 to claim a coverage exemption if your income is below your filing threshold and you choose to file a tax return. If you are not required to file a tax return and don’t want to file a return, you do not need to file a return solely to claim this exemption.

Other coverage exemptions may be claimed on your tax return using Part III, Coverage Exemptions for Individuals Claimed on Your Return, of Form 8965. Use a separate line for each individual and exemption type claimed on the return.

See the instructions for Form 8965 for more information.

28. What do I need to do if I am required to make a payment with my tax return?
If you have to make an individual shared responsibility payment, you will use the worksheets located in the instructions to Form 8965, Health Coverage Exemptions, to figure the shared responsibility payment amount due. The amount due is reported on line 61 of Form 1040 in the Other Taxes section, and on the corresponding lines on Form 1040A and 1040EZ. You only make a payment for the months you or a member of your household did not have coverage or qualify for a coverage exemption. See question 27 for information on reporting exemptions.

29. What happens if I owe an individual shared responsibility payment, but I cannot afford to make the payment when filing my tax return?
The IRS routinely works with taxpayers who owe amounts they cannot afford to pay. The law prohibits the IRS from using liens or levies to collect any individual shared responsibility payment. However, if you owe a shared responsibility payment, the IRS may offset that liability against any tax refund that may be due to you.

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How MEC plans are a great benefit to employees and employers

Each year, preventable chronic diseases are responsible for millions of premature deaths among Americans. Because health problems impact productivity, they are a major drain on the U.S. economy, resulting in 69 million workers reporting missed days due to illness each year. This loss of productivity reduces economic output by $260 billion per year.

Under the Affordable Care Act (ACA), the overarching goal of the National Prevention Strategy is to increase the number of Americans who are healthy at every stage of life. Nationally, Americans use preventative services at about half the recommended rate. Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Americans each year and account for 75% of the nation’s health spending. These chronic diseases can be controlled with preventative and wellness care and detected earlier with appropriate screenings.

Businesses can greatly benefit by allowing their employee’s access to preventative and wellness programs because a healthier workforce reduces long term health care costs, and increases stability and productivity. With better health, adults are more productive and show up for work more often. Preventing disease increases productivity – asthma, high blood pressure, smoking and obesity each reduce annual productivity by $200-$440 per person.

Minimum Essential Coverage (MEC) plans regulated by the ACA include a wealth of preventative and wellness benefits including but not limited to:

Diabetes Screening
Immunizations
Depression Screening
STI Counseling
Contraception
Heart Disease Prevention
Colon Cancer Screening
Skin Cancer Counseling
Breastfeeding Counseling
Breast Cancer Screening
Autism Screening
Dental Cavities Prevention
Iron Supplementation
Blood Pressure Screening
Tobacco Use Interventions
The right preventative care at every stage of life helps all Americans stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce costs. The FreedomCare MEC plan includes all of these benefits and more. Give us a call today.

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What Is an Open Enrollment Period?

What Is an Open Enrollment Period?

Open enrollment is a period of time each year when you can sign up for health insurance. If you don’t sign up for health insurance during open enrollment, you probably can’t sign up for health insurance until the next open enrollment period, unless you experience a qualifying event.

If you’re eligible and apply for health insurance during open enrollment, the health plan must insure you. The company is not allowed to use underwriting or require evidence of insurability, both of which could make it harder for you to get health insurance.

What Health Insurance Sources Use Open Enrollment Periods?

Open enrollment periods are common and in place for:

  • Medicare
  • Job-based health insurance
  • Individual market health insurance, as a result of the Affordable Care Act (enrollment windows apply both in the health insurance exchanges and outside the exchanges)

When Is Open Enrollment?

The time of year for open enrollment depends on the health care plan you choose:

  • Medicare open enrollment runs from October 15 to December 7 each year. Note that this does NOT apply to Medigap plans, which don’t have an annual open enrollment period. Medigap plans are only available without medical underwriting during your initial enrollment period, or during one of the very limited special enrollment periods that apply to those plans.
  • Job-based health insurance open enrollment periods are set by your employer and can happen at any time of the year. However, it’s usually in autumn so the new coverage begins on January 1 of the next year.
  • Open enrollment in the individual market (on and off-exchange) has varied considerably over the last few years. Starting with 2018 coverage, the open enrollment schedule has settled at November 1 to December 15, with all plans effective January 1 of the coming year. So open enrollment for 2018 coverage began November 1, 2017 and ended December 15, 2017 (with extensions in ten states that operate their own exchanges). This is the same time frame that is scheduled to be used for future years as well. Open enrollment for 2018 marked the first time that enrollment ended before the start of the new year, and plan selections cannot be made after the year begins (prior to 2014, enrollment was available year-round in the individual market, but in most states insurers determined eligibility based on applicants’ medical history, which meant people with pre-existing conditions could be denied coverage; that no longer happens, thanks to the ACA).  Learn more about open enrollment in the individual market.

Special Enrollment Is the Exception to Open Enrollment

Insurance plans that use an open enrollment system also have an exception that allows you to enroll outside of open enrollment under extenuating circumstances, frequently called life events. Known as a special enrollment period, this exception allows you to sign up for health insurance if you lost your other health insurance because you:

  • lost your job
  • moved
  • got divorced or married
  • became a widow or widower
  • aged off of a parent’s plan
  • let COBRA insurance expired
  • have a new baby

You won’t be eligible for a special enrollment period if you lost your other health insurance because you didn’t pay the monthly premiums, though, or if you voluntarily canceled your prior coverage.

Note that although qualifying events and special enrollment periods in the individual market are similar to those that have long existed for employer-sponsored plans, they are not identical. Here’s a guide that pertains specifically to special enrollment periods in the individual market, on and off-exchange.

What Types of Health Insurance Don’t Use Open Enrollment?

Most health insurers in the United States use some sort of open enrollment program that limits sign-ups to a particular time each year. Here are some exceptions:

  • Medicaid, the state-based health insurance, doesn’t limit enrollments to an open enrollment period. If you qualify for Medicaid, you can enroll at any time.
  • CHIP, the U.S. government’s Children’s Health Insurance Program, doesn’t limit enrollments to a particular time, either.
  • Travel insurance isn’t subject to open enrollment restrictions, either. Due to the short-term nature of travel insurance policies, they’re not usually subject to open enrollment. However, some travel insurance companies restrict your ability to purchase a travel insurance policy to the period of time immediately after you book your travel.
  • Short-term health insurance doesn’t use open enrollment periods either. Like travel insurance, short-term insurance isn’t regulated by the ACA, and plans are available year-round in states that allow them. A new rulein 2017 limited short-term plans to no more than three months in duration, but that rule is expected to be reversed under new regulations that are under review by the federal government (the previous rules allowed short-term plans to exist for up to 364 days; those guidelines might be reinstated, or there might be a new rule altogether, but the three-month limit is almost certainly going to be eliminated).
  • In some cases, supplemental insurance products. Supplemental insurance plans sold to individuals are available year-round. But if your employer offers supplemental insurance, your opportunity to enroll will likely be limited to your employer’s overall open enrollment period.

More Open Enrollment Opportunities

Most employers allow you to sign up for or change other job-based benefits during open enrollment, also. Generally, you’re only allowed to make these changes during open enrollment. For example, you may be able to:

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How to Determine if You Have Minimum Essential Coverage (MEC)

Overview

The Affordable Care Act, also known as Obamacare or ACA, requires most Americans to have health insurance that meets a government standard known as “minimum essential coverage,” or MEC. Whether your insurance qualifies as MEC depends not on the plan itself, but on how you obtained your coverage.


Employer-provided plans

Under Obamacare, any health insurance plan offered to you by an employer qualifies as minimum essential coverage (MEC). So if you and your family get health insurance through a job, you should have MEC which includes:

  • Coverage for current employees
  • Coverage for retirees
  • COBRA continuation coverage, which allows former employees to hold onto their health insurance for a certain period of time after leaving an employer
  • College students who get health insurance from their school while they’re enrolled are also considered to have MEC.

Government plans

By definition, government health insurance programs provide minimum essential coverage (MEC). These programs include:

  • Medicare, which provides benefits to people over 65 and the disabled
  • Medicaid, which is for low-income people
  • Tricare, which covers military service members and their families
  • The Children’s Health Insurance Program, or “CHIP,” a federal-state effort to cover children and pregnant women in lower-income families
  • Veterans’ health care benefits
  • Peace Corps volunteers’ health insurance

Individual plans

An “individual” health insurance plan is one you buy directly from an insurance company. That makes it different from the “group” plans typically offered by employers.

The following types of individual health insurance plans also are automatically considered to offer minimum essential coverage (MEC):

  • Any individual health insurance plan you had before Obamacare went into effect and you were allowed to keep it
  • Any plan you bought through a state or federal online insurance marketplace set up under Obamacare
  • Other individual health insurance plans may also qualify. If in doubt, your insurance company should be able to tell you whether you have MEC.

What doesn’t qualify

Certain health benefits don’t count as MEC, even though they may seem like traditional health insurance in some ways. Examples of non-MEC benefits include:

  • Plans that provide only discounts on health care services
  • Plans that cover only dental care or vision
  • Care under workers’ compensation plans
  • Plans that provide care only for a specific condition, rather than general medical coverage

Getting an Exemption

Beginning in 2019, you no longer will be assessed a penalty if you don’t have minimum essential coverage (MEC). Until then, certain individuals and families can qualify for an exemption, which avoids the penalty. If you qualify for an exemption, you can have non-MEC coverage—or no coverage at all. Among the situations that could get you an exemption:

  • Your income is so low that you aren’t required to file a tax return
  • You can’t find insurance that’s cheaper than 8% of your income
  • You’re a member of a religious group that objects to all forms of insurance
  • You are experiencing a financial hardship that makes it too expensive to get insurance
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