Wang Insurance

Blog

Open enrollment and special enrollment

A benefit of the Affordable Care Act (ACA) is that no person can be turned down for health insurance based on his or her medical history. However, the new rule is that you must sign up for health insurance during a set time frame called open enrollment. If you experience a qualifying life event, you can enroll during special enrollment.

Open enrollment

  • A time frame each year in which you can enroll, switch plans, and get subsidies.
  • Typically runs from the beginning of November to the end of January the following year

Special enrollment

  • Only time outside of open enrollment where you your family can sign up for health coverage.
  • You must qualify in order to be eligible. Qualifying events may include one of the following life-changing events:
    • Loss of health coverage (i.e. turning age 26, losing job-based health insurance, etc.)
    • Getting married
    • Having a baby
    • Moving your residence outside of your insurance plan's area
  • You typically have up to 60 days from the date of the qualifying event to enroll in a new plan, but make sure to apply as soon as possible to get the earliest effective date. Your plan will not always be effective the date it ended unless you plan ahead.
     

Things to note

  • Medi-Cal and Medicare have unique enrollment periods not subject to open Enrollment or special enrollment
  • For health benefits plans for employers, there is no set enrollment period. You can apply at any time.
     

What if I don't enroll?

  • You may have to pay a penalty, which increases each year
    • In 2015, the penalty is the higher of these two amounts:
      • 2% of your yearly household income
      • $325 per person for the year
    • In 2016, the penalty is the higher of these two amounts:
      • 2.5% of your yearly household income
      • $695 per person for the year
  • You pay the penalty on the federal income tax return