The Affordable Care Act required all states to create a marketplace through which their residents could purchase health coverage. Some states elected to offer coverage through the federal-facilitated Marketplace, known as Healthcare.gov. Other states created their own state-based marketplaces giving residents the opportunity to purchase coverage.
Each Marketplace, whether federal or state, provides health insurance options and costs of coverage. Information is also provided about eligibility for help with paying reduced premiums and out of pocket costs. When visiting www.healthcare.gov, the user is asked to provide a zip code. If the user lives in an area serviced by a state-based Marketplace, the user is redirected to the website for the state system.
The Marketplace offers an enrollment period in October each year. Once the enrollment period ends, an individual can enroll in coverage only if the individual has a life event that qualifies the person for a Special Enrollment Period.
With many employees losing health coverage as a result of the impact of COVID-19 on employers, individuals should understand the enrollment options for Marketplace coverage.
A Special Enrollment Period is available if a person (or a household member) in the past 60 days:
- Got married. If a plan is selected by the last day of the month, coverage can start the first day of the next month.
- Had a baby, adopted a child, or placed a child for foster care. Coverage can start the day of the event even if enrollment is up to 60 days later.
- Got divorced or legally separated and lose health coverage. Divorce or legal separation without losing coverage does not allow a Special Enrollment Period.
- Dies. A Special Enrollment Period is available if someone on a Marketplace plan dies and as a result a family member loses health coverage.
- Changes residence. Some household moves qualify for a Special Enrollment Period including
- Moving to a new home in a new zip code or county
- Moving to the US from a foreign country or US territory
- A student moving from or to the place of schooling
- A seasonal worker moving to or from the place of work
- Moving to or from a shelter or transitional housing.
- Loss of health insurance. A Special Enrollment Period is available if an individual or a household member loses qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days, including losing
- Job based coverage
- Individual health coverage for a self-purchased plan or policy
- Eligibility for Medicaid or CHIP
- Eligibility for Medicare
- Coverage through a family member
- Newly gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement. Enrollment must take place before coverage starts.
- Other changes
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder
- Becoming a US citizen
- Leaving incarceration
- Starting or ending service as an AmeriCorps State and Nation, VISTA, or NCCC member
A person has a limited timeperiod in which to enroll in Marketplace coverage. If an employee elects and enrolls in COBRA and terminates COBRA at a later date due to non-payment or voluntary termination, they will not be able to enroll in Marketplace coverage until the next open enrollment period. If a person exhausts their entire COBRA duration, the individual will have a special enrollment right to obtain Marketplace coverage.
An employee who loses employer health coverage should review their options for Marketplace coverage because after the Special Enrollment Period ends, enrollment is not allowed until the next open enrollment period.
For more information, visit healthcare.gov.
