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When can I make a change to my health insurance?

Keep in mind...
  • The open enrollment is the best time to make a change in health insurance
  • In open enrollment, one can add, switch, or renew health insurance
  • Open enrollment runs from November through the following January
  • Consumers can use special enrollment periods to make changes in health insurance
  • Consumers can use State extensions of the open enrollment to change health insurance
  • Consumers can use State extensions of the open enrollment to change health insurance

Buying Health Insurance

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Once each year, the rules of the Affordable Care Act provide an open enrollment period in which consumers have a right to buy health insurance. Residents that fail to get and keep health insurance coverage may have to pay the individual responsibility penalty.

Open enrollment provides an opportunity to satisfy the individual mandate by purchasing a qualified health plan. It is also an opportunity to use the features of medical care and health services of greater importance and comparison shopping for the best value.

The below-listed items satisfy the individual mandate.

  • Purchase a qualified health plan and keep coverage for 12 consecutive months
  • Enroll in Medicare (senior residents)
  • Enroll in Medicaid ( low-income residents)
  • Enroll in the CHIP( children and minors)
  • Obtain an exemption
  • Obtain an affordable health insurance exemption ( no available insurance at 8 percent of household income or less)

Open Enrollment is the Time for Changes

The rules of the Affordable Care Act provide an annual open enrollment period. The open enrollment period is the ideal time to make changes to health insurance. The open enrollment for the calendar year 2016 ran from November 1, 2015, through January 31, 2016.

During open enrollment consumers can use comparison shopping to find the best value for their individual or family situation.

After open enrollment, the rule is that consumers can no longer make changes to health insurance. They may only do so when eligible to participate in an extension of the open enrollment, or if in a special enrollment period.

For those that qualify, the CHIP Medicare, and Medicaid satisfy the Individual mandate for insurance coverage. The CHIP, Medicare, and Medicaid have continuous enrollment periods.

Changes During the Open Enrollment Period

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The annual open enrollment is a time authorized by law for the below-listed health insurance changes. When making changes, one must remember to compare.

The best way to find the plan that fits one’s needs is comparison shopping. After the open enrollment period, it is not possible to make changes to health insurance without an extension or a special enrollment period.

  • Renew an existing healthcare plan
  • Select a new plan
  • Reject an employer plan in excess of 9.5 percent of income and select a new affordable plan.
  • Cancel an existing plan and select a new one
  • Obtain an exemption for lack of affordable plans( 8 percent or less of household income)

Compliance with the Individual Mandate

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The individual mandate of the ACA requires every resident to get and keep qualified health insurance. The requirement starts with the first day of the year and continues for 12 consecutive months. Everyone must have coverage unless exempt. For example, those who do not need to file an income tax return are exempt.The government recognizes a limited type of exemption for hardship.

These events include unexpected financial crises that can overwhelm a family or individual in financial hardships. While possibly severe, these events are essentially temporary, and after one is free of difficulty, the law requires health insurance.

The government recognizes a limited type of exemption for hardship. These events include unexpected financial crises that can overwhelm a family or individual in financial hardships. While possibly severe, these events are essentially temporary, and after one is free of difficulty, the law requires health insurance.

Special Enrollment Periods

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The ACA provides opportunities to correct health coverage situations caused by a change in status that affects the insurance. These changes require a new opportunity to choose insurance in fairness to the individual or family. For example, a change of address may place the subscriber outside of the service area of the existing insurance coverage. This situation requires an opportunity to choose a policy that serves the new location.

Life events include the below-listed occurrences that create a sixty day period for making changes to health insurance.

  • Marriage
  • Divorce
  • Birth of a child
  • Loss of coverage by the 26th birthday
  • Loss of coverage by loss of a job as an employee
  • Loss of coverage by loss of job as a dependent

Compare to Save

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When enjoying the freedom to select coverage during a special enrollment period, consumers can make the best possible selection by determining the elements of plans which are most important. Using comparison shopping techniques, one can rate plans by their value to one’s individual or family situation.

For example, if one requires frequent medical visits, then it may be important to minimize co-pays and coinsurance since one must pay these consumer fees at each visit. Similarly, if one needs a service that is not in the provider’s network, then one may have to pay the entire fee. Saving on out-of-pocket expenses is a great use of comparison shopping.

For example, if one requires frequent medical visits, then it may be important to minimize co-pays and coinsurance since one must pay these consumer fees at each visit. Similarly, if one needs a service that is not in the provider’s network, then one may have to pay the entire fee. Saving on out-of-pocket expenses is a great use of comparison shopping.

Medicaid and CHIP have Continuous Enrollment

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When the change in insurance involves moving from a qualified health plan to Medicaid, then there is always an open enrollment period. Medicaid and the CHIP have continuous enrollment. One can lose income and no longer afford a marketplace plan.One may be eligible for Medicaid which has an upper-income limit.

In the event that one lives in a state that adopts Medicaid expansion, then one may discover eligibility for Medicaid’s new higher income limit. The CHIP has no income limits; it is available for children and minors who do not have means for paying for a marketplace health plan.

One may be eligible for Medicaid which has an upper-income limit. In the event that one lives in a state that adopts Medicaid expansion, then one may discover eligibility for Medicaid’s new higher income limit. The CHIP has no income limits; it is available for children and minors who do not have means for paying for a marketplace health plan.

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