<img src="//bat.bing.com/action/0?ti=5067266&amp;Ver=2" height="0" width="0" style="display:none; visibility: hidden;">
GET STARTED

Small Business Employee Benefits and HR Blog

FAQ - What If I Miss Open Enrollment for an Individual Health Plan?

rememberOne big change brought on by the Affordable Care Act (ACA) is that individual health insurance plans will have open enrollment periods -- set times when people can buy a qualified health plan through the Health Insurance Marketplace, or outside the Marketplace from an insurer or agent.

This is the first time individual health insurance has had an open enrollment period. It is needed because all individual health insurance plans ('qualified health plans') are now guaranteed-issue. Without the open enrollment periods, people would just wait to buy coverage until they got sick or needed an expensive medical procedure.

The first open enrollment period to buy a qualified health plan is happening now, running October 1, 2013 through March 31, 2014.

What If I Miss Open Enrollment?

If you miss open enrollment, and have not enrolled in a health plan by March 31, 2014, you've likely missed your chance to buy coverage for the year -- unless you have a significant change in circumstance, such as losing your job-based insurance. These significant changes are listed below.

If you miss the deadline, this also means you'll probably face a penalty for not having insurance. In 2014, the penalty is $95 per person up to a maximum of three times that amount for a family ($285), or 1% of household income if greater. The penalties increase in 2015 and 2016.

See examples of the penalty payments here.

What are the 'Significant Changes'?

You will be allowed to enroll in a qualified health plan (or change from one plan to another) outside the open enrollment period if you have a significant change in circumstance, called a 'triggering event' or a 'qualifying event'. These trigger events allow you to enroll during a special enrollment period, which lasts for 60 days after the triggering event. Here are the main triggering events:

  1. You or a dependent loses minimum essential coverage (ex: you lose job-based insurance)

  2. You gain a dependent or become a dependent through marriage, birth, adoption, or placement for adoption (ex: you have a baby, you get married)

  3. Your were not previously a citizen, national, or lawfully present individual, and you gain such status (ex: you gain US citizenship)

  4. You are newly eligible or newly ineligible for the premium tax credits or you have a change in eligibility for cost-sharing reductions, regardless of whether you are already enrolled in a qualified health plan (ex: your income changes significantly)

  5. You gain access to new qualified health plans as a result of a permanent move (ex: you move out of state)

  6. You are a Native American Indian (you may enroll in a QHP or change from one to another one time per month)

Click here to read more about the special enrollment periods, and all of the triggering events.

Summary of Important Dates for Enrolling in a QHP

Here's a summary of the important dates for enrolling in a qualified health plan.

  • October 1, 2013: Online marketplaces opened for plan shopping and enrollment. Find your marketplace at www.healthcare.gov, or with this marketplace website directory.

  • December 15, 2013: Last day to enroll in an qualified health plan, if you want coverage to start right on January 1, 2014.

  • January 1, 2014: Earliest coverage date for new qualified health plans.

  • March 31, 2014: Open enrollment for qualified health plans ends. If you miss this date, you will have to wait until fall 2014 to enroll, unless you have a qualifying event. Then you can enroll in a special enrollment period. Mark your calendar -- March 31 is the last day to sign up for a qualified health plan. 

  • November 15, 2014 - February 15, 2015: Open enrollment period for 2015 coverage. 

 The Comprehensive Guide to the Small Business HRA