Your options after March 31, 2014
Open Enrollment for 2014 coverage is over. But you may still have options to get health coverage.
See if you qualify for a Special Enrollment Period — so you can buy a private health plan through the Marketplace.
Apply for Medicaid and the Children’s Health Insurance Program (CHIP) — you can do this any time, all year. If you qualify you can enroll immediately.
Small businesses can apply for SHOP coverage any time, all year.
Members of federally recognized tribes and Alaska Native shareholders can enroll in Marketplace coverage any time of year. There is no limited enrollment period for these groups, and they can change plans as often as once a month.
If none of these options work for you, the Open Enrollment period for 2015 coverage begins on November 15, 2014.
Important: If you don’t have minimum essential coverage, you must either pay a fee or have an exemption from paying the fee.
Apply with a Special Enrollment Period
After Open Enrollment, you can enroll in private coverage through the Marketplace only if you have a qualifying life event or a complex situation related to applying in the Marketplace.
If you think you qualify for a special enrollment period, start a Marketplace application. When you finish your application and get to your “To-do list” page, you’ll see a statement that you can enroll only if you have a special enrollment period. Continue the process and enroll in a plan.
You can also contact the Marketplace Call Center to apply by phone. Be sure to tell the representative that you believe you qualify for a special enrollment period. Call 1-800-318-2596 (TTY: 1-855-889-4325) 24 hours a day, 7 days a week.
What you should know before you apply
There are a few things you should know about special enrollment periods before you apply. Make sure that you qualify for a special enrollment period.
Qualifying Life Events: Here are some examples of qualifying life events:
- Marriage, having a baby, adopting a child or placing a child for adoption or foster care, moving your residence, gaining citizenship, leaving incarceration
- Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.
- For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
- Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
Lower costs for Marketplace plans: You may be able to get premium tax credits or lower out-of-pocket costs that reduce how much you pay for coverage.
You can enroll in a plan either through the Marketplace or outside the Marketplace if you qualify for a special enrollment period but your income is too high to get lower costs.
Appeals: If you don’t appear to qualify for a special enrollment period, or if you apply and the Marketplace says you don’t qualify you can appeal a decision to deny you a special enrollment period.
Medicaid and CHIP: You can also apply for Medicaid and CHIP coverage any time if you think you may qualify.
Fees and Exemptions: Remember, if you don’t have minimum essential coverage, you must either pay a fee or have an exemption from paying the fee.
Apply for Medicaid and CHIP
You can enroll in Medicaid and the Children’s Health Insurance Program (CHIP) any time of year. There’s no limited enrollment period for these programs. You can apply any time. If you qualify you can enroll immediately.
In all states, Medicaid and CHIP provide health coverage for some individuals, families and children, pregnant women, the elderly with certain incomes, and people with disabilities. In some states the program covers all adults below a certain income level.
Find out if your state is expanding Medicaid to cover all people below a certain income level and what this means for you.
If your state is expanding Medicaid and your yearly income is below $16,105 for 1 person ($32,913 for a family of 4), you may qualify. See this chart for more household sizes and incomes.
If your state isn’t expanding Medicaid you should still apply, particularly if you’re pregnant, have young children, or have a disability. You may qualify under your state’s existing rules. Learn more about Medicaid coverage.
Your children may qualify for coverage under Medicaid or CHIP even if you don’t qualify for Medicaid.
How to apply for Medicaid and CHIP
Apply directly to your state agency. Use the menu at the bottom of the “Do I qualify for Medicaid?” page to pick your state and you'll be sent to the right place. You can apply to your state directly at any time and find out if you qualify. If you qualify, coverage can start immediately.
Fill out an application in the Health Insurance Marketplace. If it looks like anyone’s eligible for Medicaid or CHIP, we'll pass your information along to your state agency, which can help you enroll if you qualify. Start a Marketplace application now.
Private plans outside the Marketplace
In some limited cases some insurance companies may sell private health plans outside the Marketplace and outside Open Enrollment that count as minimum essential coverage.
These plans meet all the requirements of the health care law, including covering pre-existing conditions, providing free preventive care, and not capping annual benefits. If you have one of these plans, you won’t have the pay the fee that some people without coverage must pay.
Insurance companies, agents, brokers, and online health insurance sellers may offer these health plans outside the Marketplace. The Marketplace does not list or offer these plans. You can’t get premium tax credits or lower out-of-pocket costs for plans you buy outside the Marketplace.
Insurance companies can tell you if a particular plan counts as minimum essential coverage. Each plan’s summary of benefits and coverage also includes this information.
The fee for being uncovered
Your fee is calculated one of 2 ways. You’ll pay the higher of these amounts for 2014:
- 1% of your income; OR
- $95 per adult ($47.50 per child; family maximum $285)
If you’re uncovered for only part of the year, you owe 1/12 of the annual penalty for each month you don’t have coverage.
If you owe a fee, you’ll pay it on your 2014 federal income tax return. You usually file this return in 2015.
Learn more about the fee:
- “What if I don’t have coverage?”
- Details on the fee from the Internal Revenue Service.
- Exemptions from the fee
Exemptions from the fee
You may not have to pay the fee in certain situations. This is called having an “exemption.”
You may qualify for an exemption if:
- You’re uninsured for less than 3 months of the year
- The lowest-priced coverage available to you would cost more than 8% of your household income
- You don’t have to file a federal tax return because your income is too low
- Your income is below 100% of the federal poverty level and your state hasn’t expanded Medicaid
- You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
- You qualify for a hardship exemption
- You enrolled in a plan through the Marketplace by March 31, 2014, with coverage effective for May 1, 2014, even if you didn’t have coverage earlier in the year
There are more ways you may qualify for an exemption. Learn more about hardship exemptions, additional exemptions, and how to claim all exemptions from the fee.
Open Enrollment for 2015 coverage
If none of the options for getting covered outside Open Enrollment works for you, your next chance to enroll in health coverage through the Marketplace is the next Open Enrollment period.
- The Open Enrollment period for 2015 coverage is November 15, 2014 to February 15, 2015.
Coverage can start as soon as January 1, 2015.
Sign up for email updates to get important information and reminders to help you get ready for the next Open Enrollment period.
Small business insurance for employees
Businesses can begin offering coverage to their employees any time. There’s no limited enrollment period for businesses to offer coverage to their employees.
If your business has 50 or fewer full-time equivalent (FTE) employees, you can use the Small Business Health Options Program (SHOP) Marketplace to offer coverage to your workers.
If you offer SHOP coverage and have fewer than 25 employees, you may be able to get a Small Business Health Care Tax Credit.
If you’re self-employed, with no employees, you can get coverage for yourself and your family through the Health Insurance Marketplace. You will not use the SHOP Marketplace.