Haven’t Enrolled in Marketplace Health Coverage? Three Things to Know

More than 7 million people had signed up for private coverage by the time open enrollment in health reform’s insurance marketplaces ended March 31.  But, what about those who are still trying to enroll — and those who don’t need coverage now but may need it later in the year when their circumstances change?  Here are three basic points on who can sign up between now and November 15, when the next open enrollment period begins:

First, people eligible for Medicaid can sign up any time — unlike private coverage, Medicaid has no limited enrollment period.  Medicaid eligibility varies by state but, in states that chose to expand Medicaid under health reform, people with income up to 138 percent of the poverty line (about $27,000 for a family of three) can enroll.

Second, people who began signing up in the federal marketplace at healthcare.gov by March 31 have until April 15 to finish and enroll in a plan.  And people who experienced problems with healthcare.gov or have other exceptional circumstances can get additional time.  In states with their own marketplaces, the deadlines vary, so check the marketplace website for details.

Third, many people who lose other coverage (such as Medicaid or job-based coverage) or experience other changes can enroll in marketplace coverage during “special enrollment periods” (SEPs).

Most major life changes trigger a SEP:

• Losing other health coverage;
• Moving to a different state, or even within a state if the move changes which plans are available;
• Getting married; and
• Having a baby or adopting a child.

But some significant life changes don’t trigger a SEP by themselves, such as getting divorced (unless the person getting divorced loses coverage or moves).  Losing a job without losing coverage also doesn’t trigger a SEP.

For more information on special enrollment periods and other health reform topics, check out CBPP’s special project Health Reform:  Beyond the Basics.