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What Happens If I Miss the Open Enrollment Period for 2016?

Man typing on laptop for the Affordable Care Act Open Enrollment

While it may be premature to worry about missing the upcoming open enrollment period for 2016, it may be good to know the consequences. In 2016, the penalty for not having health insurance in 2015 will increase substantially from the fine levied for the failure to obtain coverage in 2014.

In fact, you could be looking at putting a major dent in your wallet by paying $695 for an uninsured adult, and up to $2,085 per household or 2.5 percent of your income – whichever is greater. However, all is not lost. You may be able to enroll in coverage outside the normal Covered California open-enrollment period, if you experienced what is considered a “qualifying life event”.

Depending on your circumstance, there are a number of different legitimate life events under the Affordable Care Act and Covered California that could give you a reprieve and make you eligible for special enrollment.

Life events that may qualify you for a Special Enrollment outside the open enrollment period include, but are not limited to:

Getting married
Having a baby
Adopting a child or placing a child for adoption or foster care
Losing other health coverage
Moving to a new permanent residence
Gaining citizenship or lawful presence in the U.S.
Leaving incarceration
Delay in having a divorce finalized
For people already enrolled in Marketplace coverage:
o A change in income or household status that directly affects eligibility for premium tax credits or cost-sharing reductions
o Important: Quitting your Marketplace plan voluntarily mid-year doesn’t make you eligible for a Special Enrollment Period.

You could also qualify for a special enrollment with other life events, such as losing your employer-sponsored insurance plan, but this may require contacting your insurance plan’s customer service to discuss the matter for further evaluation.

Don’t wait until you’re sure to get a fine for not obtaining some sort of health coverage. If you’ve had any change in your plan or you’ve experienced a life event, contact Covered California or a Freeway Insurance agent as soon as possible to discuss your options.
If you’re lucky enough to qualify, applying for health coverage through the special enrollment isn’t much different from the normal open-enrollment period. You’ll choose the Covered California health insurance plan that works best for you – and, better yet – you won’t have to worry about paying a penalty for not having health insurance.

However, should none of the qualifying life events listed apply, the good news is – you may still be eligible for health care through Medi-Cal or California’s Access for Infants and Mothers (AIM) program for pregnant women. These plans include the same 10 essential health benefits as the Covered California plans. Of course, eligibility for these programs is based on your income and your application will be reviewed for coverage through Medi-Cal and AIM – no matter which life event you select.

In the end, citizenship and residency status, typically, will decide eligibility. And, if you don’t meet Medi-Cal’s requirements, there are optional plans offered by Covered California for immigrants to choose from. However, health insurance for undocumented immigrants may still be a possibility under certain circumstances, though on a limited scale.

Freeway Insurance, the premier healthcare insurance broker, is partnering with Covered California and some of the nation’s most trusted carriers to help those following a qualifying life event obtain health insurance. Freeway’s services to find you the best health insurance quote and guide you through the confusing sign-up process are 100% free.
Why not speak with a Freeway Insurance professional about special enrollment or to sign-up for the first time? Cover all your bases so you can avoid paying a fine for missing Covered California’s open enrollment 2016.

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