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Doctor holding up Affordable Care Act sign

The Affordable Care Act substantially changed the health insurance market. One of the most recognized changes it brought was the individual mandate. This law requires most Americans to carry health insurance.

It is imperative that Americans enroll in a health insurance plan. Most Americans enroll during a yearly period called open enrollment, which is typically on either end of the holiday season. However, many Americans can also qualify for special enrollment periods.

Let's take a closer look at the difference between these enrollment options.

Open Enrollment

Open enrollment occurs at a specific time every year, though this period may vary depending on the party that provides insurance. During this period, Americans are generally able to change their coverage or enroll in new plans.

You have to maintain coverage once you get it. If you don't, you might face financial penalties. So, it's imperative to keep your policy active at all times.

Special Enrollment Periods

After an open enrollment period ends, many Americans cannot enroll in health insurance again until the next one starts. However, Americans may face circumstances that require them to sign up for health insurance outside of open enrollment.

Special enrollment periods allow qualified individuals to enroll in health insurance after the standard open enrollment. These periods usually last around 60 days.

A variety of circumstances may lead to special enrollment periods. These may include:

  • Someone losing or quitting their job.That person may lose their health insurance as a result. A reduction in working hours might also trigger special enrollment periods.
  • An employer no longer offering health insurance coverage.
  • Employers offering health insurance that doesn't meet Affordable Care Act mandates. In this case, employees may qualify for credits or cost assistance through the ACA marketplace.
  • Losing coverage from a private plan you already carry.
  • Losing federal health insurance coverage, such as Medicaid, Medicare, COBRA or CHIP coverage.
  • Losing coverage through a family member. For example, children can stay on their parents' plans until they are 26 years old. However, once they turn 26, they often must get their own coverage. Therefore, they may qualify for special enrollment.
  • Moving, getting married, divorcing or having a baby. These significant life changes may qualify individuals for special enrollment.

Other circumstances may lead to special enrollment periods in specialized cases. For example, a newly naturalized U.S. citizen will often have to enroll in health insurance in short order.

Since most Americans have to carry health insurance, they have to make use of open enrollment or special enrollment periods to get coverage. The right attention to enrollment will help them avoid health insurance penalties.

We've got you covered. Call Simpson Financial Group, Inc. at (978) 222-3939 for a fast, free health insurance quote.

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Suite 102
Marlborough, MA 01752


(978) 222-3939
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Attention: This website is operated by Simpson Financial Group, Inc. and is not the Health Insurance Marketplace website. In offering this website, Simpson Financial Group, Inc. is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov.

Simpson Financial Group, Inc., which has licensed insurance agents in 50 states. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer's enrollment in a health plan. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled.