A qualifying event opens the door to purchase coverage outside of open enrollment.
Open enrollment for 2015 health insurance has ended. It ran from November 15, 2014 through February 15, 2015.
Outside those dates, you must have a qualifying event in order to be eligible to purchase Affordable Care Act-compliant coverage which is effective in 2015.
NOTE: Anthem has extended its deadline to purchase off-exchange 2015 coverage until February 28. Click here for more info.
Examples of Qualifying Events
- Change in marital status (marriage/divorce/death of a spouse)
- Relocation to a new state
- Change in family size (birth/adoption/death of a child)
- Loss of minimum essential health coverage (change in employment status, cancellation of current coverage)
- Certain changes in income
- Expiration of COBRA
Qualifying Events Trigger a Special Enrollment Period
A qualifying event triggers a special enrollment period during which you can enroll in a health insurance plan outside of open enrollment.
Most special enrollment periods last 60 days, so be sure to act quickly if you have one of these events.
If You Have a Qualifying Event
If you do have a qualifying event, you must have proof of the event. When applying for coverage, you will be asked to submit verification of the event and the date it occurred. Without verification, most carriers will not process the application.
If you have a qualifying event and you are eligible for a subsidy (click here to find out), then you must purchase coverage on your state’s health insurance exchange in order to collect the subsidy (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents).
If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:
What if You Don’t Have a Qualifying Event?
Absent a qualifying event, most individuals will not be able to purchase Affordable Care Act (ACA)-compliant health insurance coverage for 2015 after February 15*. Instead, you will need to wait until next year’s open enrollment to buy coverage effective in 2016.
If you are concerned about being uninsured for the remainder of 2015, you may have an option to purchase a temporary policy as a bridge through the end of the year.
Temporary plans offered outside of a special or open enrollment period will not be ACA-compliant. One critical missing piece will be coverage for pre-existing conditions; they will not be covered. But you would be covered for any new illness or injury that arises. Although not ideal, a temporary plan is better than having no coverage at all.
Here are two companies we work with that offer short term, temporary coverage:
Virginia Medical Plans Can Help
If you have a qualifying event, let us know right away so we can help you find new coverage that will best meet your needs.
Even without a qualifying event, if you do not have health insurance, give us a call. We may be able to help you at least find a temporary policy to give you peace of mind until 2016.
Give us a call at 703-707-8270.
*Exception — Anthem BC/BS has extended its deadline to purchase off-exchange 2015 plans to February 28, 2015. Click here for more information.
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