For most people the last day to enroll in a Marketplace plan in 2016 was the January 15, 2016. But in some cases, you may still have options for coverage this year.
Who can Qualify for Special Enrollment Period?
If you have certain lifestyle changes – like having a baby, getting married or losing health coverage – can qualify for a Special Enrollment Period . If you do, you can enroll in a plan outside the Market Open Enrollment Period. If none of these options works for you, you can enroll in health coverage during the upcoming 2017 Open Enrollment Period, which begins in fall 2016.
2016 Special Enrollment Period
After January 15, 2016, only you can enroll in a health plan through 2016 Health Insurance Market, if you have a life event that entitles you to a Special Enrollment Period.
Life changes that may qualify for a Special Enrollment Period:
- Having a baby
- Adopting a child or placed a child for adoption
- Loss of other coverage
- Moving out of your residence
- Get citizenship
- Becoming a member of an Indian tribe. The members of indigenous tribes recognized by the federal government may enroll or change plans once a month throughout the year .
- Being released from jail
- For people who are already enrolled in coverage insurance market: having a change in income or family status affecting their eligibility for tax credits or cost-sharing reductions.
Appealing Special Enrollment Decision by Health Care Marketplace
If you disagree with a decision taken by the Health Insurance Market, you may file an appeal.
Decisions you can appeal
You may appeal the following types of decisions of the Insurance Market:
- If you are eligible or not to purchase a plan Insurance Market
- If you can enroll in a plan or insurance market outside the regular registration period
- If you are eligible or not for lower costs based on income
- The amount of savings for which you are eligible
- If you are eligible or not for Medicaid or Medical Insurance Program for Children (CHIP)
When you apply for coverage in the insurance market, you will receive a notice of eligibility explains what qualifies. This notice will provide appeal instructions for each person in your household, including the number of days it has for appeal.
Appealing Health Insurance Marketplace Decision
Consider this important information when planning an appeal:
- You can select another person to submit or participate in its appeal. That person can be a friend, relative, lawyer or someone else. Or you can handle yourself of the appeal.
- If you make an appeal, you may maintain your eligibility for coverage while your appeal is pending. You will receive a letter describing your options.
- The results of an appeal may change the eligibility of other household members.
According to their status and results of eligibility, you may appeal through the insurance market. Or you may have to file an appeal with Medicaid or CHIP agency in your state. Your letter will explain.
Your eligibility determination letter will explain how to file an appeal. In general, you can appeal their eligibility in 2 ways:
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
or using an online form available in the healthcare portal.
Expedited Healthcare Marketplace Appeals
You may request an expedited appeal if the delay time for a standard appeal could jeopardize your life or ability to obtain, maintain or regain their skills to the fullest. Your request for expedited appeal should specifically explain how affected if life or ability to obtain, maintain or regain their skills to the max would, if I had to wait within a standard appeal. Your request for expedited appeal as quickly as possible is processed. The final decision must be made as soon as required by your medical condition.