Affordable Care Act: Applying for Special Enrollment Period

The application for special enrollment varies slightly from state to state. However, there are a few things you can expect to see across the board to help prepare for when you do apply.
07/15/2014 12:52 pm ET Updated Sep 14, 2014

Affordable Care Act. Obamacare. Open enrollment. Special enrollment. Life Changes. Exemptions.

These are all terms Americans will need to familiarize themselves with before filing this year's taxes. For the first time, most Americans are required to have health insurance coverage or be assessed a tax penalty when filing their 2014 tax returns in 2015. Under the Affordable Care Act, if you were uninsured, the deadline for enrollment through the online Health Insurance Marketplace was March 31, 2014 -- however, if you missed the deadline, there are still a few life events that may qualify you for a special 60 day enrollment period to obtain health insurance coverage.

What is the special enrollment period and how do I know if I qualify?

Regular open enrollment for health insurance closed on March 31 this year and doesn't open again until November 15, 2014. However, the government will grant a special 60-day window if you've experienced a certain life change, allowing you to purchase health insurance through the online Marketplace outside of the open enrollment period.

In order to qualify, you have to have experienced a major life event. These include milestones like:

• Marriage or divorce
• Having a baby, adopting a child, or placing a child for adoption or foster care
• Moving your residence, gaining citizenship, leaving incarceration
• Gaining or losing a dependent
• Losing other health coverage (loss of job, COBRA expiration, aging off parent's plan, etc.)
• Graduating college
• Gaining status as a member of an Indian Tribe
• If you have already obtained health care coverage through the marketplace, 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.

For a full list, you can visit TurboTax Health.

Okay, I think I qualify. Now what?

The application for special enrollment varies slightly from state to state. However, there are a few things you can expect to see across the board to help prepare for when you do apply.

1. Don't wait.

The 60-day period will start on the date of your qualifying event (not the date you apply) so make sure to get a jump on your application as soon as possible.

2. Have your basic information handy.

You'll be asked to set up an account so it will be beneficial to have all of your information ready for every family member who needs coverage. This includes the basics like name, date of birth, social security number and contact information. Information like household income and number of people in your household will help determine what plans and discounts your household qualifies for.

3. Know what documentation you need.

In some states you will be able to verify your qualifying life event electronically simply by selecting the type of the event and the date; in others, you will need to submit documentation to prove that this event occurred.

4. Choose your plan carefully.

Once you have your information entered, you'll be presented with plan options and fact sheets. Make sure to read your options carefully so you know how you're covered and are educated to choose the plan that best fits your household needs.

What if I don't qualify for special enrollment?

File an appeal. Denied? Don't fret. In the event your application for special enrollment is denied, you can file an appeal, in which you will receive a response within 90 days. If 90 days would jeopardize your life or ability to function normally you can file an expedited appeal.

Apply for Medicaid or CHIP. You also have the option to file for Medicaid or CHIP coverage at anytime during the year if eligible.

Remember the grace period. If you are uninsured for less than three months of the year you will not be assessed a tax penalty on your 2013 taxes.

Don't forget the new open enrollment dates. Open enrollment period in the Health Insurance Marketplace opens November 15, 2014 through February 15, 2015.

You may be exempt. Check to see if your new circumstances also make you eligible for an exemption to purchase health insurance under the Affordable Care Act.