- The requirement that the insurance companies write all "comers" took away the insurance element and now the premiums reflect that.
- The requirement that everyone have insurance will be, could be, enforced with the 1095 filings and from the thousands that have come across my screen in the past weeks, the poorest will be punished.
The Centers for Medicare and Medicaid Services (CMS) recently announced that they have retired certain qualifying life events for consumers searching for coverage outside of the Affordable Care Act's nationwide open enrollment period. CMS has also made it more difficult to qualify for some of the special enrollment opportunities that are still available (1).
Qualifying Life Events - And How to Prove You Are Eligible
The following describes common qualifying life events that may allow you to enroll in a major medical health insurance plan after open enrollment ends, as well as the paperwork you may need to provide in order to show that you're eligible.
- Loss of qualifying employer coverage: Some insurers require a letter from your former employer that confirms your loss of coverage as well as the date and the reason it occurred. The letter should include the names of the employee and dependents affected. Some insurers will accept a letter showing eligibility for COBRA if it provides the same details listed above.
- Loss of COBRA coverage: If you were previously insured through COBRA, some insurers require you to provide a copy of the letter you should have received stating that your COBRA coverage has now been exhausted.
- Birth or adoption of a child: Some insurers require a copy of the child's birth certificate and/or placement or adoption papers, with a court seal.
- Adding a new dependent: When a child moves in with you for reasons other than birth or adoption, you may need to provide a copy of a court order (in case of a divorce or custody settlement) or school admissions documentation or transcripts.
- A permanent move to a new coverage area: You may be required to show copies of utility bills from both your former and the new residence, dated within sixty days of the date of your move. Mobile phone bills and bank statements are typically insufficient.
- Marriage or divorce: A copy of the marriage license (translated into English, if necessary) or a court-stamped copy of the divorce decree may be required.
- Change of income that alters your eligibility for assistance: You may be required to provide documentation of your eligibility for subsidies. This is generally obtained through the government health insurance exchange serving your state.
What to Expect When Enrolling in Coverage with a Qualifying Life Event
You may have questions about what to expect when enrolling in coverage outside of the nationwide open enrollment period. Here are a few things you should know:
- You have sixty days to enroll. If you experience one of the qualifying life events described above, you will typically have a sixty-day window to enroll in a new health insurance plan.
- Loss of prior coverage due to lack of payment is not a qualifying life event. If your old plan was cancelled because you failed to pay your monthly premiums, this is not considered a qualifying life event and will not allow you to enroll in a new plan outside of the nationwide open enrollment period.
- Not all major life events are considered "qualifying" life events. For example, pregnancy is not considered a qualifying life event, though the birth of a child is. If you were previously uninsured at your old address, moving to a new coverage area is not considered a qualifying life event. Cancelling coverage under your old plan because it is too costly or cancelling your COBRA coverage because it is too costly are not qualifying life events. Loss of coverage under a short-term health insurance plan is not a qualifying life event.
- Having your paperwork handy can speed things up. It can be difficult to obtain the paperwork you may need from former employers or utility companies proving that you have experienced a qualifying life event. Work to obtain these things as quickly as possible after your qualifying life event so that your sixty-day special enrollment window doesn't close before you can sign up for a new plan.
- It can take a few weeks to confirm your eligibility: The time required for an insurance company to confirm your eligibility to enroll may vary from insurer to insurer. It may take 2-3 weeks in some cases, or even longer at busy times of year. Note that your coverage will generally not take effect immediately after approval, but may require 2-6 weeks from the date your application is approved.
(1) Refer to the January 19, 2016 CMS announcement on retired special enrollment periods and to the January 19, 2016 CMS clarification on residency requirements for special enrollment periods.