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Open Enrollment Explained

Healthcare ReformHealth Care Reform: Open Enrollment Explained

By: John Rico, Owner: Rico, Pfitzer, Pires and Associates Insurance Agency, Inc.

Open enrollment is the only time of the year you can obtain a major medical plan that counts as minimum essential coverage in the Individual and Family Market without qualifying for a special enrollment period. This is true for both inside and outside the health insurance marketplace.

Health Care Open Enrollment Dates Through the Marketplace and Health Insurance Companies

• Open enrollment for 2014 plan year ended March 31, 2014;
• Open enrollment for 2015 plan year is November 15, 2014 – February 15, 2015 (subject to change).

Federal Financial Assistance for Medical Insurance Costs

• Federal financial assistance is available to help pay for the cost of your health insurance purchased through the Marketplace-another benefit of health care reform. Two types of government assistance are available, depending on your income level, tax credits and cost sharing reductions.

Qualifying Life Event

• Is a change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage?

Special Enrollment Period

• Is a time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. Under the Affordable Care Act, the following 9 events trigger a special enrollment period, which extends for two months (60 days) beyond the month of a triggering event.

The Nine Triggering Events

1. A qualified individual and any dependents losing other minimum essential coverage (includes those circumstances described in 26 CFR 54.9801-6(a)(3)(i) through (iii) which include: loss of Medicaid and CHIP–as a result of a reported change in household income, or as a result of other circumstances);

2. A qualified individual gaining or becoming a dependent through marriage, birth, adoption, or placement for adoption;

3. An individual, not previously lawfully present, gaining status as a citizen, national, or lawfully present individual in the U.S;

4. Consistent with the Medicare Prescription Drug Program, a qualified individual experiencing an error in enrollment;

5. An individual enrolled in a QHP adequately demonstrating to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract;

6. An individual becoming newly eligible or newly ineligible for advance payments of the premium tax credit or experiencing a change in eligibility for cost-sharing reductions (does not apply if they become eligible for an increase or decrease in their existing advance payments of the premium tax credit; however if an individual experiences a change in his or her existing payments of the premium tax credit in tandem with a change in level of cost-sharing reductions, the individual could qualify for this special enrollment period);

7. New QHPs offered through the Exchange becoming available to a qualified individual or enrollee as a result of a permanent move (includes Qualified individuals newly released from incarceration);

8. The individual is an Indian, as defined by the Indian Health Care Improvement Act;

9. A qualified individual or enrollee meeting other exceptional circumstances, as determined by the Exchange or HHS.

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