What is a Qualifying Event and What Should I Do if I Have One?

Note: this post was originally published on May 12, 2014 but has been updated for 2015.

When it comes to health insurance, a qualifying event is a life event that makes you eligible to purchase health insurance outside the dates of open enrollment.  A qualifying event triggers a special enrollment period lasting 30-60 days, depending on the event.  Read more about special enrollment periods.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)

• Relocation to a new state or to an area of your current state where the plans offered are different

• Change in family size (birth/adoption/death of a child)

• Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)

• Certain changes in income

• Expiration of COBRA benefits

Newly added by the Department of Health and Human Services (HHS) and effective April, 2015:

• A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs. You could switch, for example, from single to family coverage during a special enrollment period. HHS is not mandating this change until 2017, but is encouraging exchanges to offer it as soon as possible.

• An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.

• If a court order requires someone to provide health insurance (for example during divorce proceedings), the coverage must be available the first day the court order takes effect, even if that date is outside open enrollment.

• If you have a pre-Affordable Care Act plan which does not run on a calendar year basis, and that coverage terminates outside the dates of open enrollment.

What Should You Do if You Have a Qualifying Event?

If you do have a qualifying event, you must have proof of the event in order to be eligible to purchase a new plan.  When applying for coverage, you will need 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 will need to purchase coverage on your state’s health insurance exchange (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:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

But remember, you have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.

Give our office a call at 703-707-8270 and we’d be glad to help.

Buying 2015 Health Insurance Outside of Open Enrollment

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:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

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:

• Assurant Health
• UnitedHealth Care

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.

What is a Qualifying Event and What Should I Do if I Have One?

Note: this post was originally published on May 12, 2014 but has been updated for 2015. What appears here is the updated information, as of March 2015.

When it comes to health insurance, a qualifying event is a life event that makes you eligible to purchase health insurance outside the dates of open enrollment.  A qualifying event triggers a special enrollment period lasting 30-60 days, depending on the event.  Read more about special enrollment periods.

Examples of Qualifying Events

• Change in marital status (marriage/divorce/death of a spouse)

• Relocation to a new state or to an area of your current state where the plans offered are different

• Change in family size (birth/adoption/death of a child)

• Involuntary loss of minimum essential health coverage (change in employment status, cancellation of current coverage)

• Certain changes in income

• Expiration of COBRA benefits

Newly added by the Department of Health and Human Services (HHS) and effective April, 2015:

• A change in family structure — for example becoming a dependent or gaining a dependent through birth, adoption, or placement in foster care — which causes your current plan to no longer meet your needs. You could switch, for example, from single to family coverage during a special enrollment period. HHS is not mandating this change until 2017, but is encouraging exchanges to offer it as soon as possible.

• An increase in your income to the federal poverty level (FPL) if you live in a state which has not expanded Medicaid. Earning at least 100% of FPL takes you out of the Medicaid coverage gap and makes you eligible for premium tax credits when buying health insurance on the exchange.

• If a court order requires someone to provide health insurance (for example during divorce proceedings), the coverage must be available the first day the court order takes effect, even if that date is outside open enrollment.

• If you have a pre-Affordable Care Act plan which does not run on a calendar year basis, and that coverage terminates outside the dates of open enrollment.

What Should You Do if You Have a Qualifying Event?

If you do have a qualifying event, you must have proof of the event in order to be eligible to purchase a new plan.  When applying for coverage, you will need 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 will need to purchase coverage on your state’s health insurance exchange (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:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Assurant Health
• Innovation Health/Aetna

But remember, you have a limited amount of time after a qualifying event to purchase new coverage, so you must act quickly.

Give our office a call at 703-707-8270 and we’d be glad to help.

Buying Health Insurance After March 31 During a Special Enrollment Period

2014 open enrollment may have ended for most people, but a qualifying event will open the door to a special enrollment period.

March 31 has come and gone.  And with it has come the end of open enrollment for 2014 health insurance plans.

Unless you had already begun an application on or before that date through healthcare.gov (the federal health insurance exchange used by Virginia residents), March 31 was the last day you could purchase non-group health insurance coverage during 2014 open enrollment.

However, there may still be an opportunity to purchase 2014 coverage during what is known as a special enrollment period.

Special Enrollment Period Triggered by a Qualifying Event

A special enrollment period is a window of time during which you can enroll in a health insurance plan outside the dates of open enrollment. A special enrollment period is triggered by certain qualifying events.

In most cases, the period lasts 60 days from the date of the qualifying event. However, in the case of the loss of a pre-Affordable Care Act policy due to non-renewal by the carrier, the special enrollment period lasts for 30 days.

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

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 need 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 will need to purchase coverage on your state’s health insurance exchange (healthcare.gov for Virginia residents, marylandhealthconnection.com for Maryland residents, dchealthlink.com for DC residents). Click here for instructions.

If you are not eligible for a subsidy, you can apply directly with the carrier of your choice:

• CareFirst BC/BS
• Anthem BC/BS
• Kaiser Permanente
• Humana
• UnitedHealth Care
• Innovation Health/Aetna

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 2014 after March 31.  Instead, you will need to wait until next year’s open enrollment — Nov 15, 2014 to Feb 15, 2015 — to buy coverage effective in 2015.

If you are concerned about being uninsured for the remainder of 2014, 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 before 2015.  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:

• Assurant Health
• UnitedHealth Care

We 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 2015.

Call us at 1-800-867-0800 or send us an email at jkatz@vamedicalplans.com.