ACA Special Enrollment Periods

The ACA special enrollment period is part of Obamacare. One of the crucial things to keep in mind when signing up for any healthcare program is that many times, certain plans may only be enrolled in during specific enrollment periods. If beneficiaries fail to enroll during this time, they may be barred from enrolling late, or if they do manage to enroll late, they may face increased premiums or fees. One thing to note about Obamacare enrollment periods is that they are subject to change. Not all enrollment periods will change depending on the circumstances, but some will. If there is a reason for a beneficiary being unable to enroll during his or her initial enrollment period, he or she may be eligible for special enrollment periods. For more information on the ACA special enrollment periods, review the following topics:

  • What are Special Enrollment Periods?
  • How to Register for Special Enrollment Periods
  • What to Expect if a Special Enrollment Period Application is Rejected

What are Special Enrollment Periods?

Special enrollment periods are times in which prospective beneficiaries will be able to sign upfor or change health insurance via the health insurance Marketplace. Because of the nature ofhealthcare insurance, beneficiaries cannot wait until their general enrollment periods are upand then apply for special enrollment periods. Furthermore, depending on the circumstancessurrounding the need for a special enrollment window, one beneficiary may have a longerspecial enrollment period than another.

For example, losing healthcare coverage will open a special enrollment period of at least 120days, whereas being denied Medicaid or CHIP will open a 60-day special enrollment period fromthe date of denial. Some of the most common reasons to need a special enrollment period are: losing other healthcare coverage, marriage, adoption or birth,death, changes in income and household status, gaining citizenship and incarceration. All prospective beneficiaries who arelooking to apply for special enrollment periods must meet all of the state requirements forspecial enrollment. Some of these stipulations include: being a legal resident or acitizen of theUnited States, and not currently incarcerated.

How to Register for Special Enrollment Periods

The enrollment process for special enrollment periods is a straightforward process, and is donethrough the Marketplace either online or by phone. In most cases, an application will have tobe filled out and then sent through the health insurance Marketplace to be processed. Theapplication should have the general information, such as name,address and Social Securityinformation. There should also be a spot on the application to explain the circumstances thatwould lead to needing a special enrollment period, along with documentation. Documentation about the circumstances must be provided for verification, or else the application will beautomatically rejected. Then, the application will be reviewed. An official notice will be sentregarding the acceptance or the denial of the special enrollment period application, and in theevent that the request is a denied, a reason will be listed.

What to Expect if a Special Enrollment Period Application is Rejected

Not everyone who applies for a special enrollment period will be granted one. In fact, it is quitecommon for special enrollment applications to be rejected for one reason or another. However,sometimes the Marketplace does make a mistake when processing documents, and it could bethe case that an application was erroneously denied. If this isthe case, a beneficiary couldsubmit an appeal. A special enrollment period appeal is when the application in question isreviewed a second time by a panel to decide if the initial rulingwas made in error.

The first step in this process is to note all the thingsin the denial notice that seem to beerroneous. Next, find the specific Florida appeal form and fill it out. Take the time to check overeverything and verify that the information on the form is correct. Once that is done, the formmust be mailed to the local health insurance Marketplace contact address so a staff membermay review the application. If it is the case that the denial wasmade in error, a beneficiary willbe able to have his or her coverage returned. Unfortunately, ifthe denial was not made inerror, there is nothing more an appeal process can do for the requestor.

If the appeal fails, a beneficiary does have other options. He or she could look at subsidizedinsurance or other public health care providers. However, if a beneficiary does not qualify for those health programs, either, he or she is advised to speakwith an agent and see what plansare available for private health insurance. Private health insurance is offered outside of themarket placeand can often simplify the health care process by putting all medical services andbenefits under one physician’s roof, though there may be other fees associated with thesetypeof plans as well.