When Can I Buy Individual and Family Health Insurance?MN Health Staff Writer | May 11, 2022
In 2010, the Affordable Care Act (ACA) changed how and when health insurance could be purchased. The ACA includes a list of healthcare policies intended to expand access to health insurance to millions of uninsured Americans. (Get a quote here) The ACA created health insurance exchanges, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage (or charging more) due to pre-existing conditions. It also allows children to remain on their parents' insurance plan until age 26. The design of the ACA was to reduce the cost of health insurance coverage for those who qualify for it. The act introduced premium tax credits and cost-sharing reductions to help lower expenses for lower income individuals and families. Premium tax credits lower your health insurance bill each month. Cost-sharing reductions, meanwhile, reduce your out-of-pocket costs for deductibles, copays, and coinsurance, as well as lowering your out-of-pocket maximum, which is the total amount you could pay in a year for covered health expenses. All ACA-compliant health insurance plans must cover specific "essential health benefits" including:
- Ambulatory patient services
- Emergency services
- Family planning
- Laboratory services
- Mental health and substance use disorder services
- Pregnancy, maternity, and newborn care
- Prescription medications
- Preventive and wellness services and chronic disease management
- Pediatric services
- Rehabilitative and habilitative service
In addition, the ACA requires most insurance plans, including those sold on the Marketplace, to cover at no cost to policyholders a list of preventative services. These include checkups, patient counseling, immunizations, and numerous health screenings. The Marketplace in Minnesota is known as MNsure.
There are a few different periods in which you can purchase health insurance in the state of Minnesota.
- The first is the Open Enrollment Period: The Open Enrollment Period is the annual period when you can enroll in a private health insurance plan or renew or make changes to a current plan. The Open Enrollment Period starts on November 1st each year, with the end date varying. The 2022 Open Enrollment Period had two parts, the first of which ran from November 1st – December 15th, with any plan that was enrolled in having a start date of January 1st. The second part of the Open Enrollment Period for 2022 ran from December 15th – January 15th, with any plan that was enrolled in having a start date of February 1st.
- The second is a Special Enrollment Period: A period of time when you can enroll in a private health plan or change to another private plan if you experience a Qualifying Life Event.
A Special Enrollment Period occurs when you have a Qualifying Life Event. Qualifying life events include:
- Adoption, Foster Care, Child Support or Court Order: Gained or lost a dependent through adoption, foster care, a child support or other order.
- American Indian or Alaska Native (can enroll or change plans once a month, year-round): For members of federally recognized tribes and non-tribal members of their households.
- Birth (only applies to newborn child): Gained a dependent through birth of a child.
- Change in Eligibility for Tax Credits: Your eligibility changes for tax credits or cost-sharing reduction. Must be currently enrolled though MNsure in a qualified health plan.
- Divorce, Legal Separation, or Death: Lose private health coverage you enrolled in though MNsure due to divorce, legal separation, or death.
- Enrollment Error: Enrollment or non-enrollment due to agency error, mistake, misrepresentation or inaction.
- Gain Lawful Presence or Citizenship: Gain citizenship or lawfully present status making you newly eligible for a qualified health plan.
- Loss of Employer COBRA Premium Subsidy: Employer ends COBRA premium subsidy.
- Lost or Will Lose Health Coverage: Lost or will lose coverage through a job, aging off a plan (turning 26), lose coverage through Medical Assistance, MinnesotaCare, or TRICARE.
- Marriage: Your household size changes because you got married.
- Moved to Minnesota: Made a permanent move to Minnesota from another state, U.S. territory or outsider the U.S.
- New HRA Offer from an Employer: New offer of an individual coverage HRA (ICHRA) or qualified small business HRA (QSEHRA) from an employer.
- Off-MNsure Plan and Income Decrease: Enrolled in coverage outside of MNsure and income decrease makes you eligible for tax-credits.
- Released from Incarceration: Released from serving a term in prison or jail.
- Residential Address Change: Made a permanent move within Minnesota to a new county or ZIP code.
- Special Circumstances: Includes AmeriCorps service, natural disaster, ineligible for Medical Assistance after final determination, or victim of domestic violence or spousal abandonment.
To qualify for a Special Enrollment Period, you will need to submit documents to prove your Life Event occurred, with document requirements varying by Qualifying Life Event. For most of these Qualifying Life Events, you will need to show proof of current insurance or proof of being previously insured within the last 60 days. You have 60 days from the date of the Qualifying Life Event to get enrolled in a health plan. Many of the Qualifying Life Events allow you to choose from a few different options for providing documents. For more specific information, visit MNsure.
Specific documents required for each Qualifying Life Event are:
- Adoption, Foster Care, Child Support or Court Order
- The court order defining the adoption, foster care or placement for adoption or foster care
- Court order defining child support
- Other court order
- American Indian or Alaska Native
- Tribal affiliation card
- Tribal affiliation document
- A certified letter or membership list from the tribe will be accepted if you do not have either one of the above documents
- The child's name and birth date.
- The birth date occurred in the last 60 days.
- Divorce, Legal Separation, or Death
- Court order with the date of divorce or legal separation
- Death certificate
- Public notice of death (example: published obituary)
- Gain Lawful Presence or Citizenship
- Birth certificate
- Certification of report of birth
- Certification of citizenship or naturalization
- Evidence of U.S. Civil Services employment before June 1, 1976
- Federal or state census record
- Final Adoption decree
- Machine-readable immigrant visa on unexpired foreign passport
- Medical records
- Military record showing U.S. place of birth
- Minnesota enhanced driver’s license or enhanced identification card
- Northern Marianas ID card
- Official religious records
- PASS card
- Report of birth abroad of a U.S. citizen
- School records
- Section 1-1 of the Child Citizenship Act of 2000 documentation
- Temporary I-551 Stamp
- Tribal Affiliation card or document
- Unexpired foreign passport
- U.S. citizen ID card
- U.S. passport
- DS2019 (certification of eligibility for exchange visitor status)
- I-20 (certification of eligibility for non-immigrant student status)
- I-94 (arrival/departure record)
- I-94 (arrival/departure record) in unexpired foreign passport
- I-327 (reentry permit)
- I-551 (permanent resident card)
- I-571 (refugee travel document)
- I-688 (temporary resident card)
- I-688A (employment authorization card)
- I-688B (employment authorization document)
- I-766 (employment authorization card)
- Other documents generally accepted as legal proof of citizenship or immigration status such as:
- Administrative order staying removal issued by the Department of Homeland Security
- Document indicating withholding of removal
- Form I-360 prima facie determinations
- Office of Refugee Resettlement
- Loss of Employer COBRA Premium Subsidy
- Employer plan notice that shows your name and the last day of the COBRA coverage period in which the COBRA premium is subsidized by your employer.
- Letter from employer that shows your name and the last day of the COBRA coverage period in which the COBRA premium is subsidized by your employer.
- Document from third-party COBRA administrator that shows your name and the last day of the COBRA coverage period in which the COBRA premium is subsidized by your employer.
- Lost or Will Lose Health Coverage
- Employer plan notice that indicates the type of coverage lost and the last date of coverage.
- Letter from employer that indicates the type of coverage lost and the last date of coverage.
- Letter from health insurance company that indicates the type of coverage lost and the last date of coverage.
- Notice of loss of benefits from a state or federal government program such as Medical Assistance, MinnesotaCare, Medicare or TRICARE.
- The marriage certificate must show your name and the date of marriage.
- The date of marriage must be within the past 60 days.
- Coverage closure or termination letter showing the last date of coverage within 60 days of the date marriage
- Documentation of premiums paid or invoice within 60 days of the date of marriage
- HIPAA certification showing coverage within 60 days of the date of marriage
- Pay stub documenting employer/insurance deduction within 60 days of the date of marriage
- Other documentation showing that the last date of coverage was within 60 days of the date of marriage
- Moved to Minnesota
- A copy of at least one of these documents to prove the date of the move:
- Current lease
- Current mortgage or real estate transition
- Recent utility bill or billing statement from the new address
- Recently issued Minnesota driver’s license or state ID
- Recently issued voter registration card
- Regarding a school-aged child, school records showing recent enrollment in school with new address
- A copy of at least one of the following documents to show your previous address:
- Previous lease
- Previous mortgage or real estate transition
- Previous state driver’s license or state ID
- Regarding a school-aged child, school records showing recent enrollment in school with previous address
- Utility bill or billing statement from the previous address
- Voter registration card from previous address
- A copy of at least one of the following documents to show you had health care coverage prior to the move:
- Coverage closure or termination letter showing the last date of coverage within 60 days of the move
- Documentation of premiums paid or invoice within 60 days of the move
- HIPAA certification showing coverage within 60 days of the move
- Pay stub documenting employer/insurance deduction within 60 days of the move
- Other documentation showing that the last date of coverage was within 60 days of the move
- New HRA Offer from an Employer
- An offer for a qualifying HRA that took effect in the past 60 days or that will take effect in the next 60 days.
- Your name, the HRA type and the start date of the benefit.
- Off-MNsure Plan and Income Decrease
- Employer notice showing the date the rate of pay was decreased.
- Pay stubs that show a decrease in the hourly wage amount or hours worked between a previous pay stub and the most recent pay stub.
- If you are self-employed, MNsure will work with you to identify the documents needed to verify the date your income decreased.
Be prepared to send verification that you had previous coverage outside of MNsure:
- Document from your previous health insurance company showing when your previous coverage ended and that you were enrolled in this coverage for at least one day in the 60 days right before your income decreased.
- Residential Address Change
Whether you are signing up during the Open Enrollment Period or the Special Enrollment Period, it is important to know the deadlines and what is needed in order to get enrolled. A local agent can also help you navigate these enrollment periods to avoid a gap in coverage and get you enrolled.
Tags: Individual and Family Plans Health Insurance MNSure
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