ACA Deadline Cheat Sheet

Posted by on in Insurance

The current healthcare marketplace can be confusing. Understanding your options, especially as they relate to the Affordable Care Act (ACA), requires some study. If you are planning to purchase a 2016 health insurance plan during the Open Enrollment Period, you need to be aware of certain dates.

The following dates are particularly important:

  • November 1, 2015 – Open enrollment started – first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace
  • December 15, 2015 – Last day to enroll in or change plans for new coverage to start January 1, 2016
  • December 31, 2015 – Coverage ends for 2015 Marketplace plans
  • January 1, 2016 – 2016 coverage starts for those who enroll or change plans by December 15
  • January 15, 2016 – Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016 – 2016 Open Enrollment ends – Enrollments or changes between January 16 and January 31 take effect March 1, 2016

If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you have experienced a life event (in the last 60 days) which qualifies you for a Special Enrollment Period. Qualifying life events include marriage, childbirth, adoption, divorce, and job loss.

The following are exceptions to the above dates:

  • Enrolling in Medicaid or the Children’s Health Insurance Program (CHIP) – These two programs provide free or low-cost health coverage to millions of Americans, including some low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. You can submit applications to these programs at any time. If you qualify, your coverage can begin immediately, at any time of year. To apply for Medicaid and CHIP, you can either apply directly to your state Medicaid agency or apply through the Health Insurance Marketplace.
  • Small Businesses – Employers are able to offer health insurance coverage through agents, brokers, or the SHOP marketplace at any time during the year.

Finding a short-term solution to coverage gaps

If you are unable to purchase an ACA plan, or if you’ll face a gap in coverage due to open enrollment policy start dates (ACA coverage gaps can be 15 to 45 days), you can still obtain coverage with Short Term Medical (STM) insurance. An STM plan is not *ACA-compliant, but it can provide you with affordable interim coverage. In addition to bridging your insurance gap, STM is also worth considering if:

  • You’re a retiree (younger than 65) in need of coverage before enrolling in Medicare
  • You’re a student transitioning from a parent’s plan
  • You’re a U.S. citizen returning from living abroad

Though not a long-term solution, STM is intended for those who need coverage for less than a year.

*Note: Since STM polices are not ACA-compliant, you will owe a fee (to be paid when you file your 2016 federal tax return) for any month you, your spouse, or your tax dependents don’t have an ACA-compliant plan.

You can avoid this fee by claiming a “short gap in coverage” exemption if you have a Short Term Medical policy (or go without ACA-compliant coverage) for no more than 2 consecutive months.

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