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What Life Events Qualify for a Special Enrollment Period Under the Affordable Care Act

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The Affordable Care Act, also known as “Obamacare,” requires most Americans to have health insurance coverage this year.

While the deadline was March 31st to enroll via the Health Insurance Marketplace, there are some circumstances which qualify people for a special enrollment period.

This allows individuals to purchase private health plans through the marketplace outside of the open enrollment period.

You may qualify for a special 60-day enrollment period if you experience one of these qualifying life events during the year:

  • Family status change: A change in family structure through marriage or divorce, having a baby, or adopting a child.
  • Change citizenship status: If you become a U.S. citizen, national, or gain lawful status.
  • Exceptional Circumstance: You faced a serious unexpected medical condition or natural disaster that kept you from enrolling.
  • Indian tribal status: Becoming a member of an Indian tribe, which allows you to sign up for or change plans once a month.
  • Move to a new coverage area: If you permanently move to a new area and gain access to new qualified health plans.
  • Loss of coverage: Losing job-based coverage, getting divorced, COBRA plan expiration or aging off a parent’s plan (when you turn 26), or if you lose coverage that meets minimum government standards.
  • College grads: If you are a recent college grad and your student health plan is ending.
  • If already enrolled in marketplace coverage: A change in income through a promotion, change in profession or household status that affects your eligibility for premium tax credits or cost-sharing reductions.
  • Victim of domestic abuse: You’re a victim of domestic abuse and previously weren’t allowed to enroll and receive advance premium tax credits separately from your spouse.

If you think you qualify for a special enrollment period, you can start by filling out a Marketplace application.

If you are eligible for health insurance through the Health Insurance Marketplace during the special enrollment period, you may still be eligible for a premium tax credit or lower out-of-pocket costs that reduce the amount you pay for health insurance even though you are applying outside of the deadline.

There are also complex situations related to applying in the Marketplace that may make you eligible for a special 60 day enrollment period.

If you don’t appear to qualify for a special enrollment period, or if you apply and the Marketplace says you don’t qualify, you can appeal a decision to deny you a special enrollment period. The open enrollment period for 2015 coverage begins on November 15, 2014.

Have more questions about life events and open enrollment?  TurboTax Health is here to answer your questions to help you understand how the new health care law impacts you.


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