Open enrollment and the Affordable Care Act

Jul 02 2014
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The rules for buying Individual health plans have changed under the Affordable Care Act (ACA). For one thing, now you can only buy a health plan during the same time period each year. This is called open enrollment. Now more changes are coming that will make it easier for people to stay in their plans for the next year.

Open enrollment

Why create an Annual Open Enrollment Period? A defined open enrollment period protects consumers. It gives them guaranteed access to health insurance, no matter what their health status is. An open enrollment period also protects insurers from consumers only buying insurance when they need it. It’s all about creating a stable marketplace.

In some cases, people can apply for an Individual health plan after the Annual Open Enrollment ends, during a “Special Enrollment Period.” But they have to have a qualifying event related to a change in family status or a loss of other coverage. Examples include:

  • Loss of coverage under an employer’s plan
  • Marriage or domestic partnership
  • Divorce
  • Birth or adoption
  • Moving to a new state

Without such an event, people have to wait until later this year when the Annual Open Enrollment Period for 2015 begins. That will be from November 15, 2014 to February 15, 2015.

Making it easy to renew plans

A new government proposal would make it easier for people to stay in their plans.

First, most people who have a plan they like wouldn’t have to take action. If they want to shop around, they can. But if they don’t, their insurer can simply renew their plan for another year. Sometimes an insurer decides not to offer a specific plan any more. If that happens, the insurer can just renew the member into a similar plan.

Second, we heard good news for people who got subsidies for their plan this year. The subsidy would simply carry over to next year, for those who qualify. The subsidy would be based on information the government has on file. People should still update their information with the exchange. That will help make sure they get the right tax credit amount.

Please note these rules are not yet final. People will get more information about next year’s plans before the 2015 Annual Open Enrollment Period begins in November.