When Can I Buy My Own Health Insurance?
Understanding the OEP (open enrollment period), and also SEP (special enrollment period) reasons you can buy health insurance throughout the year.
Anyone can buy individual or family health insurance during the OEP (open enrollment period), which is 11/01 through 12/15 of each year. The plan chosen would be effective 01/01 of the following year. You do not have to have any set reason or need for choosing health insurance in the OEP.
If you need to purchase individual or family health insurance in the Marketplace sometime during the year (an effective date other than 01/01) you need to meet a SEP (special enrollment period) reason. You will hear this reason called a “qualifying life event.” The Marketplace can even ask for proof of the SEP reason.
The SEP qualifying life events list cover just about every possible scenario we find people need to purchase their own health insurance. And you have time to consider your options….a SEP reason occurrence opens up a 60 day window for you to buy your own health insurance.
See below for an explanation of the SEPs (special enrollment periods).
The Top 6 SEP Reasons People Choose Their Own Health Insurance During the Year
These are the most common qualifying life events we see from our clients each day as we help them choose and enroll in Marketplace health insurance for themselves and for their families.
(1) Employment Change
If you lose health coverage through your employer (because you were laid off, fired, or left the job voluntarily), or if your spouse or another family member’s job loss means your health coverage (through their employer-sponsored plan) is ending, this is counted as a qualifying life event or SEP reason.
You do have choices….you may choose COBRA coverage from the previous employer. But we find it is worth the time to research and compare COBRA benefits and costs to Marketplace plans you can choose.
(2) Loss of Health Coverage
Another SEP reason or qualifying life event is losing your current health insurance in other scenarios that do not revolve around job loss.
You may have received a letter notifying you of loss of eligibility of Medicaid, or CHIP.
Or your COBRA or State Continuation coverage may have ended, and there is no eligibility left.
In rarer cases, your current Marketplace plan may be ending mid year.
Exceptions: Voluntarily canceling your health coverage or the coverage ending because you did not pay the premiums does not trigger this qualifying life event. If the coverage ending did not qualify as “minimum essential coverage” this SEP reason does not apply.
(3) Aging Out of Your Parent’s Plan
If you are covered under your parent’s health insurance plan (through work, or purchased individually), your eligibility to be covered as their dependent ends at the end of the month after your 26th birthday.
This opens up a qualifying life event where you have 60 days to choose your own health insurance plan through the Marketplace.
Note: We find many people in this scenario should have made this move years ago! The cost for your parent to cover you through their plan is usually many times higher than the cost of a Marketplace plan.
We Help Individuals and Families With These Health Insurance Plans (And More)
Two Real Life Examples of Families Benefitting from the Family Glitch Rule Fix
The Family Glitch Rule Fix details are dense and confusing. We have found a better way to understand the benefits are in real life situations. Here are two of our clients and how they will benefit from the Family Glitch rule fix.
A Family of 3 in Chapel Hill
David and Genny and their college age son live in Chapel Hill. David works in RTP, and his insurer pays 100% of the “employee only” health insurance premium. The plan is very benefit-rich.
Genny is a self-employed consultant, and their son is not working, as he is a full-time college student.
The cost for David to cover his wife and son with his employer-sponsored health insurance is $1,700 monthly!
The calculation…David’s monthly income is $7,000 and Genny’s monthly income is $5,000.
$12,000 income x 9.96% = $1,195.20. So the $1,700 monthly cost of the group plan for dependent coverage is deemed unaffordable.
Thus, the Family Glitch Rule Fix allows David and Genny to shop for an health insurance plan to cover Genny and their son in the Marketplace with tax credits to help lower the cost. David remains with his employer-sponsored plan, at no cost to him.
A Couple in Durham
Richard and Pauline live in Durham. Richard recently retired at age 63, but is putting off accepting Social Security or retirement benefits, so his current income is $0.
Pauline is a North Carolina state employee. She is covered by the State Health plan, Enhanced PPO 80/20.
The current State Health plan rates stipulate that Pauline must pay $94 monthly to be covered, and $680 monthly to cover her dependent spouse Richard. Her monthly income is $5,750.
The calculation…Pauline’s $5,750 income x 9.96% = $572.70. So the $774.00monthly cost of the group plan is deemed unaffordable.
The Family Glitch Rule Fix allows Richard and Pauline to shop for an individual health insurance plan for Richard in the Marketplace with tax credits to lower the cost. Pauline remains with the State Health plan at the low $74 monthly premium cost.
Chip Millard is a member of Healthcare.gov's "Champions Circle."
A distinction awarded by Healthcare.gov to health insurance agents and brokers who go above and beyond to increase access to health insurance (helping local people understand their benefits and costs options, and helping them enroll) in their communities.
Free Family Glitch Rule Fix Calculation and Quotes
Complete the form below and Chip will send you an email with a calculation of whether or not your family’s income and insurance details mean you qualify for tax credits in the Marketplace to cover your dependents due to the Family Glitch Rule Fix. He will include ideas of health insurance plans you can choose, along with details on costs and benefits.
Note: Privacy is something we take seriously. The minimum of information is shared with an insurance company to put together a detailed free quote and illustration for you.