A common misunderstanding is that an individual can enroll in an Affordable Care Act (ACA) plan at any time during 2022. This is not the case at all. Open Enrollment is scheduled to end on January 15th and ACA compliant plans will not be available again until the next Open Enrollment period, for plan year 2023. The exception to next year’s Open Enrollment period would be a Qualifying Life Event, which would create a Special Enrollment Period (SEP).
Examples of a qualifying event would include:
- Significant change in income
- Change in personal status such as marriage, divorce, legal separation, or death of a spouse
- Birth, adoption or death of a dependent
- Loss of your employment, or spouse’s employment or dependent’s employment
- Dependent’s loss of coverage due to age, like turning 26
Any of these events would afford a period of guaranteed issue for an ACA compliant plan if the application was submitted within 60 days of the date of the qualifying event. In addition to qualifying for an ACA compliant plan, the individual will also avoid the penalty.
After Open Enrollment ends on January 15th, the only policies available will either be short-term policies, which range between 1 month and 12 months of coverage, or limited benefit plans. Short-term coverage will not provide benefits for any preexisting condition that existed prior to the effective date of the short-term coverage. Short-term plans are also subject to underwriting review, which means the application could be declined due to health history. Limited benefit or indemnity plans as they are also known typically offer a fixed schedule of benefits for medical services and the insured is responsible for the balance. These plans will have annual maximum benefits and there is never an out-of-pocket maximum assigned to the plans.
Both short-term and limited benefit plans are not ACA compliant and the policyholder will be subject to the personal responsibility penalty. Currently under ACA compliant plans, there is no underwriting, no health questions, no waiting period for preexisting conditions and all plans are guaranteed issue.
Applications for January 1, 2022 effective dates must be submitted by Tuesday, December 15. If submitted before the January 15, 2022 deadline you will have a February 1 effective date.
STATESIDE CAN HELP!
Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.
Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs.
Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods.
Phone Appointment Reservation.
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for