Understanding Open Enrollment, Qualifying Life Events, and Special Enrollment Periods

There are many terms and concepts associated with health insurance. Some are more general, while others can be a little more complicated to understand.

Some terms you may have been hearing a lot lately are open enrollment, special enrollment period, and qualifying life event. Let’s break these concepts down and get a better understanding of these popular health insurance coverage terms.

First, let’s talk about open enrollment and why it exists. Open enrollment is the annual period in which consumers can purchase or change their health insurance plans. Before the Affordable Care Act (ACA), Americans could generally purchase or change their health insurance plans anytime during the year. But since the ACA restricted insurance companies from denying coverage to individuals with pre-existing conditions, health insurance companies needed some type of protection against adverse selection. Adverse selection is a term used to describe the phenomenon by which consumers or producers of products or services can dictate favorable outcomes of a purchase that are knowingly and equally less favorable to the other party. Restricting the time in which consumers can enroll with open enrollment periods helps to discourage this from taking place. The most recent open enrollment period just ended on January 15, 2022, but individuals may still qualify for the Special Enrollment Period.

Special Enrollment Period allows individuals to enroll in a health insurance plan who have experienced a qualifying life event or QLE.

A QLE is any life event that may affect an individual’s options for health insurance.

Examples for some common QLE’s include, but are not limited to:

  • Getting married or divorce
  • Having or adopting a baby
  • Moving
  • Losing previous coverage
  • And more…

You can find out if you qualify for Special Enrollment Period by visiting Healthcare.gov and answering a few questions. If you qualify, you will be granted the ability to enroll in an affordable healthcare plan.

The Medicare program offers a Special Enrollment Period, though eligibility requirements are a little different.

It is helpful to know that there are health care programs that have no enrollment time restrictions, and individuals may apply at any time. These include Medicaid and CHIP, short-term health insurance plans, and supplemental health insurance.

Medicaid and CHIP are programs where individuals must qualify to get access to coverage.

Short-term health insurance plans are helpful for individuals who need temporary health coverage to bridge any gaps between meeting the requirements and time restrictions for regular, long-term health insurance plans. Restrictions vary by state for short-term health insurance plans.

Supplemental health insurance pays for medical costs not covered in primary health insurance plans, (such as deductibles). Some plans even cover essential bills (such as mortgage payments) that you may not be able to pay due to a medical emergency.

The ACA was implemented to help make health insurance coverage more accessible to all Americans. While more Americans are insured, there are restrictions in place to help the health insurance industry and consumers alike.

If you experience a QLE or have questions about your eligibility status for Special Enrollment Period, please call Jackson Insurance Group for more information at (662)432-1698.

Jackson Insurance Group
Healthy. Happy. Insured.

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