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Category: What To Know

How does the “marriage” special enrollment work?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

When you get married, you can qualify for a special enrollment period (SEP).  You and your spouse can sign up for coverage in the Marketplace. The special enrollment period lasts for 60 days from the date of marriage.  If you enroll in coverage through the marriage SEP, coverage will start on the first day of the following month.

If you live in a HealthCare.gov state, restrictions apply.  To be eligible for the marriage SEP, at least one of you must have been enrolled in minimum essential coverage (such as a job-based plan, Marketplace plan, or Medicaid) for at least 1 day during the 60 days preceding the date of marriage.

There are exceptions to this limit on marriage SEP eligibility:

  • If at least one spouse was living in a foreign country or U.S. territory during the 60-days prior to enrollment, the prior coverage requirement does not apply
  • If at least one spouse is a member of a federally recognized Native American tribe or an Alaskan Native, the prior coverage requirement does not apply

In addition, for people currently enrolled in the Marketplace through HealthCare.gov, the marriage SEP can only be used either to add the new spouse to the current Marketplace plan or to enroll the new spouse in a separate Marketplace plan.  The currently-enrolled spouse cannot use the marriage SEP to change plans.

This restriction on plan selection does not apply for Native Americans or Alaska Natives, or for victims of domestic abuse or spousal violence.

These restrictions on eligibility for the marriage SEP and on plan selection do not apply in the SHOP Marketplace or for people using an SEP to join an employer-sponsored group health plan.

Can I buy or change private health plan coverage outside of Open Enrollment?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

In general, you can have a special enrollment opportunity to sign up for private, non-group coverage during the year, other than during Open Enrollment period, if you have a qualifying life event. Events that trigger a special enrollment period (SEP) are:

  • Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity
  • Marriage (limitations apply)
  • Gaining a dependent (for example, if you give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity in most states
  • Loss of coverage due to loss of dependent status (for example, because of divorce, legal separation, death, or “aging off” a parents’ plan when you turn 26)
  • A permanent move to another state or within a state if you move outside of your health plan service area (limitations apply)
  • Exhaustion of COBRA coverage
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program
  • For people enrolled in a Marketplace plan, income increases or decreases enough to change your eligibility for subsidies
  • Change in immigration status
  • Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.

Note that some triggering events will only qualify you for a SEP in the health insurance Marketplace; they do not apply in the outside market. For example, if you gain citizenship or lawfully present status, the Marketplace must provide you with a special enrollment opportunity.

When you experience a qualifying event, your SEP will last 60 days from the date of that triggering event.  If you can foresee loss of other coverage (for example, you know the date when you will graduate and lose student health coverage) you can ask the Marketplace for a SEP up to 60 days in advance so new coverage will take effect right after your old coverage runs out.  However, in HealthCare.gov states, you cannot ask for an advance SEP if you anticipate coverage loss due to a permanent move.

When can small employers enroll in coverage through the SHOP Marketplace?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year.  HealthCare.gov no longer operates a SHOP Marketplace website for small employers, however.  If you want to sponsor small group coverage through the Marketplace for your employees, you can contact Hummingbird Insurance to book an appointment!  In HealthCare.gov states, you can find a SHOP-certified broker using the Find Local Help tool.  Be sure to specify to the insurer or broker that you want a SHOP policy.

Can I buy a plan in the Marketplace if I don’t have a green card?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

If you are not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S., you are not eligible to buy a plan on the health insurance Marketplace. However, you can shop for health insurance outside of the Marketplace in the non-group market. Insurers outside of the Marketplace are prohibited from turning you down based on your health status or your immigration status and must follow generally the same rules as plans in the Marketplace. To obtain coverage, contact a state-licensed health insurance company or a licensed agent or broker. Your state Department of Insurance can help you find one.  

Can I get help with my Marketplace application?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Yes! Hummingbird Insurance offers free consultations and help through our certified agents. If you need help with understanding which plan is best for you, book an appointment with us today! Working with us is always free and can help you to save money.

Additionally, all state Marketplaces are required to offer Navigator programs to help consumers complete their application for  financial help, including help applying for Medicaid or CHIP.  Navigators also help people review their plan choices and appeal Marketplace decisions.  Navigators are paid by the Marketplace, not by health plans, and they must complete Marketplace training and be free from conflicts of interest.

When can I enroll in private health plan coverage through the Marketplace?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

In general, you can only enroll in non-group health plan coverage during the Open Enrollment period.

Once the Open Enrollment period is over, individuals and families will not be able to enroll in Marketplace health plans until the next Open Enrollment period. However, if you experience certain changes in circumstances during the year, you will have a special 60-day opportunity to enroll in Marketplace health plans, outside of the Open Enrollment period.

For individuals and families buying non-group coverage on their own, outside of the Marketplace, you can only enroll in coverage during Open Enrollment periods and special enrollment opportunities, as well.

American Indians and Alaska Natives can enroll in Marketplace coverage throughout the year, not just during Open Enrollment.

Who can buy coverage in the Marketplace?

Written by HummingbirdinsAdmin on . Posted in Frequently Asked Questions.

Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated.

Not everybody who is eligible to purchase coverage in the Marketplace will be eligible for subsidies, however. To qualify for subsidies (also called premium tax credits) people will have to meet additional requirements having to do with their income and their eligibility for other coverage.