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Can You Use a Healthcare Exchange After Open Enrollment?

Author: Matthew Davis

If you're looking to buy insurance from a healthcare exchange, timing can be critical. That's because, if you didn't sign up prior to March 31 this year, you'll ordinarily have to wait all the way until Nov. 15, when the next open enrollment period begins.

However, there are quite a few exceptions to this rule, so those who find themselves without insurance midway through the year can take heart. While you can buy individual coverage outside of an exchange at any time, there are some drawbacks. For one, you won't be eligible for tax credits that can help take the sting out of your insurance bill.

Here are some of the scenarios which may allow you to enroll after the standard open enrollment period.

Qualifying Life Event

If you recently experienced a major event in your life, the government may provide an exemption from open enrollment rules.

These qualifying life events include:

  • Getting married or divorced
  • Having a baby
  • Adopting a child
  • Moving your residence
  • Gaining citizenship
  • Getting out of prison
  • Gaining or losing a dependent
  • To see more life events, click here.

If you experience any of these changes, you'll want to report it immediately at HealthCare.gov or by calling (800) 318-2596. If you're eligible, you'll have 60 days from the life event to sign up for coverage. Therefore, it pays to notify the Marketplace as quickly as possible.

Losing Existing Coverage

In many cases, losing your existing health coverage enables you to take advantage of the Special Enrollment Period. You may have reached a birthday that disqualifies you from your parent's plan. Or perhaps you were dropped from a plan you had through your employer.

If so, let the Marketplace know immediately so you have enough time to research plans on an exchange. Just be aware that this exception only applies if you lost your coverage involuntarily. If you cancel your policy thinking you'll be able to sign up through an exchange, you'll find yourself out of luck.

Medicaid/CHIP Exclusion

Yet another exception applies to consumers who receive benefits through Medicaid or the Children's Health Insurance Program (CHIP), which you can apply for year-round. If you have low to moderate income, it may not hurt to see whether you qualify for healthcare through these programs.

If you live in a state that chose to expand Medicaid as part of the Affordable Care Act, you typically qualify if you're an individual and have annual income of less than $16,105 – or less than $32,913 for a family of four. According to Healthcare.gov, it's a particularly good idea to apply if you're pregnant, raising small children or have a disability, as these factors make it easier to meet the requirements of these programs.

The Bottom Line

Even if you missed the March 31 deadline, you may be able to sign up for coverage through an exchange in 2014. The government provides numerous exceptions for those who recently experienced a major change in their life or who are eligible to receive Medicaid or CHIP benefits.

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