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Applying for Individual Health Insurance due to Qualifying Events

The open enrollment period to purchase health insurance for compliance with the Affordable Care Act ended in March, but quite a few people missed the deadline. If you missed the open enrollment period you basically have two options:

  • Pay the pentalty for not being insured
  • Apply for private coverage under a qualifying life event

If you are still interested in applying for insurance, you can only do so at this point through a qualifying life event. There are certain life changing events that can make you eligible for a special enrollment period. When these events occur, if you do not already have coverage you may be eligible to apply for a private plan through the Marketplace.

Qualifying Events

Not every life-changing event will make you eligible for the special enrollment period, so it is important to know if you qualify for the exemption before you attempt to apply for coverage. Here is a list of events that may qualify you for the enrollment period:

  • Marriage
  • Having a child, placing a child up for adoption or foster care
  • Moving to a different state
  • Becoming a citizen
  • Getting out of prison
  • Losing your current coverage through job loss
  • COBRA coverage expires
  • Aging off of your parent’s plan
  • Losing eligibility to Medicaid
  • Change in income or household status for current enrollees
  • Being a member of a federally recognized Indian tribe
  • Divorce

If you have currently experienced one of these life altering events, then you can apply for coverage through the Marketplace, or you can contact a health insurance agent outside of the Marketplace to assist you in finding the coverage you require for your health needs. You must apply for coverage within 60 days in CA.

It’s important to note that if you, for whatever reason, voluntarily decide to terminate your current health insurance coverage voluntarily, you will not qualify for the special enrollment period, and unless you have an exemption, you will have to pay the penalty for being uncovered.

There is an appeals process available for those who apply for a special enrollment period due to a qualifying life event but are turned down for coverage. If you believe you should still qualify you can fill out the appeal request.

Those who are changing jobs do not have to worry about obtaining a special enrollment period, as small businesses offering insurance are able to purchase plans any time of the year from SHOP.

Individuals who are going to pay the penalty, but would like to enroll for 2015 can do so starting November 15, 2014 to February 15, 2015.

To find out if your event qualifies, visit our website and follow the instructions for applying for insurance coverage. Depending on your situation, it might be a good idea to sit down with a licensed health insurance professional and discuss the details of the event, as well as what coverage is best suited for the health care needs of you and your family.