Updated: July 6, 2016
Expanding access to health care coverage was one of the primary goals of the Affordable Care Act. As people adjust to the requirements under the law, the government and private insurers want to make sure individuals have the opportunity to enroll in coverage, especially as they face major life and family changes.
Open enrollment is officially closed for 2016, but you may still be able to get health care coverage if you have a qualifying event.
Fees for Not Having Coverage
It’s important to note that as part of the Affordable Care Act’s individual mandate, you may owe a fee for not having minimum essential health care coverage. The fee has gone up for 2016 and will increase again for 2017.
If you don’t have minimum essential coverage this year and do not qualify for an exemption, the fee is the higher of two options: 2.5 percent of your yearly household income above the tax filing threshold (about $10,300 for an individual in 2016); or $695 per adult ($162.50 for children under 18), up to a maximum of $975. The penalty will not exceed the annual premium of the bronze health care plan.
Exemptions to the law are available to some individuals based on income or hardships.
Federal Extended Enrollment Period
The federal-sponsored marketplaces are allowing people to enroll in coverage for this year a little longer. You may be able to get coverage if you meet the following three criteria:
- You didn’t know the law required you to have coverage, or you didn’t understand how that requirement affected you.
- You owe the fee for not having 2015 coverage.
- You aren’t already enrolled in a qualifying plan for this year.
- Open enrollment for 2016 health coverage ended January 31, 2016.
- If you didn't enroll by January 31, 2016, you can't enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period.
Qualifying Events for Enrollment
Certain life events happen that cause you to lose your health coverage or change your health plan. Most public and private insurers allow you to enroll in a new plan or make changes outside the enrollment period if you have a qualifying event. These include things that cause changes to income, loss of coverage, or changes to your family or household size.
Qualifying events include:
- Getting married
- Having a baby
- Adopting a child or placing a child for adoption or foster care
- Moving outside your plan’s coverage area
- Gaining citizenship or lawful presence in the United States
- Loss of coverage because of divorce or loss of employment
- Aging out of a parent’s plan
- COBRA coverage ending
Most insurers give you about 60 days from the event to make changes.
Other Changes to Your Plan
If you already have a Marketplace plan, you can update your information throughout the year. Changes in income or household status can affect your subsidy and possibly qualify you for changes to your premium.
Before contacting your insurer, make sure you have all your and your dependents’ information available, including birth dates, social security numbers, and income information such as Forms W-2.